{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:36:55Z","timestamp":1787027815888,"version":"build-2736575974"},"reference-count":29,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T00:00:00Z","timestamp":1758585600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Institutional Open Access Program (IOAP) of the University and University Hospital of Z\u00fcrich"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: Lymph node metastases represent the most important prognostic factor for survival in patients with localized squamous cell carcinoma (SCC) of the oral cavity. In patients with carcinoma of the tongue or floor of the mouth, elective neck dissection (END) has been the standard of care, but it has been replaced at many centers by sentinel lymph node biopsy (SLNB). This study\u2019s purpose was to measure and compare recurrence rates between END and SLNB in patients with early SCC of the oral cavity. Methods: Patients were included in this retrospective monocenter cohort study, performed at the University Hospital of Z\u00fcrich, if they underwent either END or SLNB for oral squamous cell carcinoma (OSCC) of the tongue or floor of the mouth between January 2008 and December 2018. Only patients with early-stage tumors and a clinically negative neck (T1 or T2; cN0) who had a follow-up period of at least 5 years were included. Patients with a T3 or T4 tumor or a clinically positive neck were excluded, as were those who previously underwent therapy for another head and neck carcinoma. The predictor variable was the surgical treatment used, with subjects divided into two groups: END and SLNB. The main outcome variable was the time to recurrent disease, defined as the time between the primary surgical treatment and the diagnosis of recurrence. The covariates were primary tumor location, pT status, pN status, histopathological grade and postoperative radiotherapy. We used descriptive analysis, univariate analysis and the logrank test, with a p-value &lt; 0.05 considered statistically significant. We deliberately refrained from multivariate analysis due to insignificant statistical results in the univariate analysis. Results: In total, 82 patients (46 male, 36 female; median age at the time of surgery: 58.9 years) were included, with a median observation period of 4.3 years. The main primary tumor location was the floor of the mouth (62.2%). The SLNB cohort had smaller primary tumors in comparison to the END cohort (20% vs. 37% pT2, respectively). Furthermore, pN+ disease was more prevalent in the END group in comparison to the SLNB group (81.8% vs. 74.1% pN0, respectively). Recurrence-free survival was not significantly different between the two groups. Subgroup analysis demonstrated a higher risk of recurrent disease in pN+ groups undergoing SLNB compared to those undergoing END. Conclusions: We demonstrate that SLNB is a useful tool for assessing lymph nodes of the neck. In cases of pN+ necks after SLNB and subsequent neck dissection, patients need to be closely followed up with due to the risk of recurrent disease.<\/jats:p>","DOI":"10.3390\/cancers17193098","type":"journal-article","created":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T13:48:37Z","timestamp":1758635317000},"page":"3098","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Sentinel Lymph Node Biopsy Versus Elective Neck Dissection in Carcinoma of the Tongue and Floor of the Mouth"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2703-9699","authenticated-orcid":false,"given":"Carolin","family":"Naegeli-Pullankavumkal","sequence":"first","affiliation":[{"name":"Department of Cranio-Maxillo-Facial and Oral Surgery, University Hospital Z\u00fcrich, 8091 Z\u00fcrich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamara","family":"Manser","sequence":"additional","affiliation":[{"name":"Department of Cranio-Maxillo-Facial and Oral Surgery, University Hospital Z\u00fcrich, 8091 Z\u00fcrich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarun","family":"Mehra","sequence":"additional","affiliation":[{"name":"Comprehensive Cancer Center Z\u00fcrich, University Hospital Z\u00fcrich, 8091 Z\u00fcrich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7043-3456","authenticated-orcid":false,"given":"Niels Jan","family":"Rupp","sequence":"additional","affiliation":[{"name":"Department of Pathology and Molecular Pathology, University Hospital Z\u00fcrich, 8091 Z\u00fcrich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Gander","sequence":"additional","affiliation":[{"name":"Department of Cranio-Maxillo-Facial and Oral Surgery, University Hospital Z\u00fcrich, 8091 Z\u00fcrich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4849-3292","authenticated-orcid":false,"given":"Martin W.","family":"Huellner","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, University Hospital Z\u00fcrich, 8091 Z\u00fcrich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Lanzer","sequence":"additional","affiliation":[{"name":"Department of Cranio-Maxillo-Facial and Oral Surgery, University Hospital Z\u00fcrich, 8091 Z\u00fcrich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1002\/hed.24589","article-title":"Changing epidemiology of oral squamous cell carcinoma of the tongue: A global study","volume":"39","author":"Ng","year":"2017","journal-title":"Head Neck"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1016\/S0002-9610(05)80109-6","article-title":"Lymph node prognostic factors in head and neck squamous cell carcinomas","volume":"168","author":"Mamelle","year":"1994","journal-title":"Am. J. Surg."},{"key":"ref_3","first-page":"477","article-title":"Predictive significance of tumor depth and budding for late lymph node metastases in patients with clinical N0 early oral tongue carcinoma","volume":"11","author":"Hori","year":"2017","journal-title":"Head Neck"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"282","DOI":"10.5125\/jkaoms.2018.44.6.282","article-title":"Clinical analysis of neck node metastasis in oral cavity cancer","volume":"44","author":"Sharma","year":"2018","journal-title":"J. Korean Assoc. Oral Maxillofac. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1002\/jso.23221","article-title":"Incidence of occult cervical metastasis in head and neck carcinomas: Development over time","volume":"107","author":"Psychogios","year":"2013","journal-title":"J. Surg. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1097\/01.mlg.0000195366.91395.9b","article-title":"Treatment of contralateral N0 neck in early squamous cell carcinoma of the oral tongue: Elective neck dissection versus observation","volume":"116","author":"Lim","year":"2006","journal-title":"Laryngoscope"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1002\/hed.23017","article-title":"Occult metastases detected by sentinel node biopsy in patients with early oral and oropharyngeal squamous cell carcinomas: Impact on survival","volume":"35","author":"Broglie","year":"2013","journal-title":"Head Neck"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1016\/j.bjoms.2014.03.020","article-title":"Does elective neck dissection in T1\/T2 carcinoma of the oral tongue and floor of the mouth influence recurrence and survival rates?","volume":"52","author":"Kelner","year":"2014","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3181","DOI":"10.1007\/s00405-020-06538-y","article-title":"What is the role of sentinel lymph node biopsy in the management of oral cancer in 2020?","volume":"278","author":"Civantos","year":"2021","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1245\/ASO.2005.11.024","article-title":"The second international conference on sentinel node biopsy in mucosal head and neck cancer","volume":"12","author":"Stoeckli","year":"2005","journal-title":"Ann. Surg. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2668","DOI":"10.1002\/(SICI)1097-0142(19991215)86:12<2668::AID-CNCR11>3.0.CO;2-R","article-title":"International union against cancer. classification of isolated tumor cells and micrometastasis","volume":"86","author":"Hermanek","year":"1999","journal-title":"Cancer"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.21873\/invivo.11380","article-title":"Can complete axillary node dissection be safely omitted in patients with early breast cancer when the sentinel node biopsy is positive for malignancy? An update for clinical practice","volume":"32","author":"Gera","year":"2018","journal-title":"In Vivo"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1016\/j.suc.2018.04.001","article-title":"Management of the axilla in the patient with breast cancer","volume":"98","author":"Park","year":"2018","journal-title":"Surg. Clin. N. Am."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"151","DOI":"10.3747\/co.25.3729","article-title":"Clinical practice guidelines in breast cancer","volume":"25","year":"2018","journal-title":"Curr. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1016\/j.bjoms.2018.06.019","article-title":"Biopsy of the sentinel lymph node in oral squamous cell carcinoma: Analysis of error in 100 consecutive cases","volume":"56","author":"Holden","year":"2018","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1007\/s12105-009-0132-3","article-title":"Head and neck sentinel lymph node biopsy: Current state of the art","volume":"3","author":"Sloan","year":"2009","journal-title":"Head Neck Pathol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1016\/j.ijom.2018.10.011","article-title":"Sentinel lymph node biopsy for early stage tongue cancer\u2014A 14-year single-centre experience","volume":"48","author":"Hingsammer","year":"2018","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1016\/j.oraloncology.2014.07.020","article-title":"Sentinel lymph node biopsy in clinically N0 T1-T2 staged oral cancer: The Dutch multicenter trial","volume":"50","author":"Flach","year":"2014","journal-title":"Oral Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2777","DOI":"10.1016\/j.ejca.2015.08.023","article-title":"Sentinel European Node Trial (SENT): 3-year results of sentinel node biopsy in oral cancer","volume":"51","author":"Schilling","year":"2015","journal-title":"Eur. J. Cancer"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1016\/j.oraloncology.2013.04.006","article-title":"Sentinel node biopsy for squamous cell carcinoma of the oral cavity and oropharynx: A diagnostic meta-analysis","volume":"49","author":"Govers","year":"2013","journal-title":"Oral Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1002\/jso.25494","article-title":"Sentinel lymph node biopsy for management of the N0 neck in oral cavity squamous cell carcinoma","volume":"120","author":"Loree","year":"2019","journal-title":"J. Surg. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Liu, M., Wang, S.J., Yang, X., and Peng, H. (2017). Diagnostic efficacy of sentinel lymph node biopsy in early oral squamous cell carcinoma: A meta-analysis of 66 studies. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0170322"},{"key":"ref_23","first-page":"3185","article-title":"Entinel lymph node biopsy versus elective neck dissection in squamous cell carcinoma of the oral cavity with a clinically N0 neck: Systematic review and meta-analysis of prospective studies","volume":"10","author":"Ding","year":"2010","journal-title":"Head Neck"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"den Toom, I.J., Boeve, K., Lobeek, D., Bloemena, E., Donswijk, M.L., de Keizer, B., Klop, W.M.C., Leemans, C.R., Willems, S.M., and Takes, R.P. (2020). Elective neck dissection or sentinel lymph node biopsy in early stage oral cavity cancer patients: The Dutch experience. Cancers, 12.","DOI":"10.3390\/cancers12071783"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1111\/j.1600-0714.2004.00289.x","article-title":"Sentinel lymph nodes in cancer of the oral cavity\u2014Isolated tumour cells","volume":"34","author":"Thomsen","year":"2005","journal-title":"J. Oral Pathol. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"436","DOI":"10.4103\/0973-029X.190946","article-title":"Detection of cervical lymph node micrometastasis and isolated tumor cells in oral squamous cell carcinoma using immunohistochemistry and serial sectioning","volume":"20","author":"Dhawan","year":"2016","journal-title":"J. Oral Maxillofac. Pathol."},{"key":"ref_27","unstructured":"Montpellier, U.H. (2018, November 26). Randomized, Open-Label Economic and Medical Study on the Lymph Node Management of Squamous Cell Carcinoma of the Oral Cavity and Oropharynx Tumor Stage 1 or 2, Nodes 0 (T1-T2 N0) Operable (SentiMERORL). National Library of Medicine, Available online: https:\/\/clinicaltrials.gov\/ct2\/show\/NCT02855723."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"0432","DOI":"10.34133\/research.0432","article-title":"Thyroid Cancer Central Lymph Node Metastasis Risk Stratification Based on Homogeneous Positioning Deep Learning","volume":"7","author":"Yao","year":"2024","journal-title":"Research"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"12524","DOI":"10.1002\/cam4.5966","article-title":"Sentinel node-assisted neck dissection in advanced oral squamous cell carcinoma\u2014A new protocol for staging and treatment","volume":"12","author":"Bark","year":"2023","journal-title":"Cancer Med."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/19\/3098\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:47:46Z","timestamp":1760035666000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/19\/3098"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,23]]},"references-count":29,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["cancers17193098"],"URL":"https:\/\/doi.org\/10.3390\/cancers17193098","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,23]]}}}