{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T20:56:19Z","timestamp":1788555379619,"version":"build-2803163510"},"reference-count":38,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Identifying the causes of sentinel lymph node biopsy (SLNB) failure in early-stage oral cavity squamous cell carcinoma (OCSCC) is essential for refining surgical protocols and optimizing patient selection. This study aimed to evaluate the diagnostic performance, predictors of false-negative (FN) results, and long-term oncological outcomes of SLNB in patients with early-stage OCSCC. Methods: A retrospective, single-centre cohort study was conducted on 220 patients with cT1\u2013cT2 N0 M0 OCSCC who were surgically treated between 2017 and 2024. Preoperative lymphatic mapping was performed using 99mTc-nanocolloid and SPECT\/CT. All sentinel lymph nodes (SLNs) underwent an ultrastaging protocol involving serial sectioning and immunohistochemistry. Diagnostic accuracy, survival outcomes, and clinicopathological predictors of FNs were analysed. Results: The SLN identification rate was 99.1%. Metastatic involvement was detected in 49 patients (22.3%), preventing 77.7% of the cohort from undergoing unnecessary neck dissection. Bilateral lymphatic drainage was observed in 55.9% of floor of the mouth tumours. During a median follow-up of 36 months, the diagnostic performance showed a sensitivity of 81.7%, a negative predictive value of 93.6%, and an overall accuracy of 95.0%. Analysis of the 11 FN cases showed that both depth of invasion (DOI) (6.0 mm vs. 3.0 mm; p = 0.010) and maximal tumour dimension (25 mm vs. 15 mm; p = 0.0008) were significant predictors of diagnostic failure. The five-year overall survival rate was significantly superior in patients with negative SLNs compared to the SLN-positive group (82% vs. 61%; p &lt; 0.001). Conclusions: SLNB is an accurate and reliable staging tool for early-stage OCSCC, providing personalised lymphatic mapping that harmonizes oncological efficacy with the avoidance of overtreatment. However, an increased DOI and a larger tumour size significantly raise the risk of FN events, indicating the need for close postoperative surveillance in these high-risk subgroups.<\/jats:p>","DOI":"10.3390\/jcm15072545","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T15:10:24Z","timestamp":1774537824000},"page":"2545","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Sentinel Lymph Node Biopsy for Early-Stage Oral Cavity Cancer: Analysis of Diagnostic Accuracy and False-Negative Cases"],"prefix":"10.3390","volume":"15","author":[{"given":"Rodrigo","family":"Lozano-Rosado","sequence":"first","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Virgen del Rocio University Hospital, 41013 Seville, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8480-4342","authenticated-orcid":false,"given":"Alvaro","family":"De-Bonilla-Damia","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Virgen del Rocio University Hospital, Instituto de Biomedicina (IBIS), 41013 Seville, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guiomar","family":"Martin-Lozano","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Virgen del Rocio University Hospital, 41013 Seville, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6007-3151","authenticated-orcid":false,"given":"Alberto","family":"Garcia-Perla-Garcia","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Virgen del Rocio University Hospital, 41013 Seville, Spain"},{"name":"Department of Surgery, School of Medicine, University of Seville, 41009 Seville, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2624-1454","authenticated-orcid":false,"given":"Jose-Luis","family":"Gutierrez-Perez","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Virgen del Rocio University Hospital, 41013 Seville, Spain"},{"name":"Department of Stomatology, School of Dentistry, University of Seville, 41009 Seville, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2770-8573","authenticated-orcid":false,"given":"Pedro","family":"Infante-Cossio","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Virgen del Rocio University Hospital, 41013 Seville, Spain"},{"name":"Department of Surgery, School of Medicine, University of Seville, 41009 Seville, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"key":"ref_1","first-page":"209","article-title":"Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J. 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