How adequate is supraomohyoid neck dissection for node-negative oral tongue squamous cell carcinoma?

Background: Oral tongue squamous cell carcinoma (SCC) has the most nodal metastasis among all oral cancers and this nodal involvement considerably lowers survival. The presence of occult metastasis in lower neck levels or skip metastasis to level IV or V complicates the effectiveness of supraomohyoid neck dissection (SOHND) for node-negative (N0) T1/T2 oral tongue SCC.

Objective: To evaluate the necessity of extended SOHND in managing N0 T1/T2 oral tongue SCC.

Methods: This retrospective cross-sectional study utilized institutional records of all histopathologically confirmed T1/T2 oral tongue SCC cases with N0 neck from a mixed Indian population who underwent extended SOHND between 2008 and 2024. The primary outcome was the positivity rate of level IV. Covariates included demographic factors such as age and sex. Positivity rates and their 95% confidence intervals were calculated.

Results: The study included 111 cases meeting the inclusion and exclusion criteria. Positivity rates for levels I-III were 35.5% (32/111; 95% CI = 0.16-0.47), while positivity for level IV was 9% (10/111; 95% CI = 0.0083-0.13). Occult metastasis to level IV was found in only 6.3% (7/111) of cases.

Conclusions: The likelihood of occult metastasis to level IV in T1/T2 N0 oral tongue SCC is very low (6.3%). The extended SOHND covers this extremely low risk (6.3%). Neglecting to address level IV in cases of occult metastasis could result in missing a crucial positive node, leading to a failure to administer necessary postoperative radiotherapy.