{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T19:07:41Z","timestamp":1789499261903,"version":"build-2803163510"},"reference-count":22,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: This study investigated clinicopathological factors associated with occult cervical lymph node metastasis in clinically node-negative oral cavity squamous cell carcinoma (OCSCC). Materials and Methods: This retrospective study included 108 patients who underwent primary tumor resection and elective neck dissection. Depth of invasion (DOI), lymphovascular invasion (LVI), perineural invasion, and histological grade were evaluated. Receiver operating characteristic analysis and multivariable logistic regression were used to assess associations with pathological nodal positivity. Results: Occult nodal metastasis was identified in 27 patients (25%). The cohort-derived DOI threshold was 8.5 mm, with an area under the curve of 0.841. LVI and histological grade were associated with nodal positivity in the multivariable analysis, although the adjusted estimates were imprecise. Conclusions: Histopathological characteristics were associated with occult nodal metastasis in this selected surgical cohort. However, the limited number of nodal events and the postoperative availability of key variables restrict clinical applicability. These exploratory findings require independent validation and should not be used to determine whether elective neck dissection can be omitted.<\/jats:p>","DOI":"10.3390\/medicina62091772","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T18:23:53Z","timestamp":1789496633000},"page":"1772","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic Efficacy of Clinico-Pathological Parameters in Predicting Nodal Positivity in Oral Cavity Squamous Cell Carcinoma: A Multivariate Risk Assessment"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8449-4965","authenticated-orcid":false,"given":"Deniz","family":"Baklac\u0131","sequence":"first","affiliation":[{"name":"Department of Otolaryngology, Zonguldak B\u00fclent Ecevit University, 67100 Zonguldak, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3975-3547","authenticated-orcid":false,"given":"G\u00f6khan Furkan","family":"K\u0131l\u0131\u00e7","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Zonguldak B\u00fclent Ecevit University, 67100 Zonguldak, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4164-9726","authenticated-orcid":false,"given":"H\u00fcseyin","family":"I\u015f\u0131k","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Zonguldak B\u00fclent Ecevit University, 67100 Zonguldak, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7262-181X","authenticated-orcid":false,"given":"Aleyna","family":"\u015eiveto\u011flu","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Zonguldak B\u00fclent Ecevit University, 67100 Zonguldak, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7973-2719","authenticated-orcid":false,"given":"Duygu","family":"Erdem","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Zonguldak B\u00fclent Ecevit University, 67100 Zonguldak, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1159\/000398801","article-title":"Oral cavity cancer: Risk factors, pathology, and management","volume":"29","author":"Ernani","year":"2015","journal-title":"Oncology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.coms.2018.08.002","article-title":"Oral cavity cancer","volume":"31","author":"Ettinger","year":"2019","journal-title":"Oral Maxillofac. Surg. Clin. N. Am."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1016\/j.soc.2015.03.006","article-title":"Cancer of the oral cavity","volume":"24","author":"Montero","year":"2015","journal-title":"Surg. Oncol. Clin. N. Am."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1001\/jamaoto.2023.4049","article-title":"Oral cavity cancer surgical and nodal management: A review from the American Head and Neck Society","volume":"150","author":"Eskander","year":"2024","journal-title":"JAMA Otolaryngol. Head Neck Surg."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Alqutub, S., Alqutub, A., Bakhshwin, A., Mofti, Z., Alqutub, S., Alkhamesi, A.A., Nujoom, M.A., Rammal, A., Merdad, M., and Marzouki, H.Z. (2024). Histopathological predictors of lymph node metastasis in oral cavity squamous cell carcinoma: A systematic review and meta-analysis. Front. Oncol., 14.","DOI":"10.3389\/fonc.2024.1401211"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e227","DOI":"10.1002\/ctd2.227","article-title":"Lymph node metastasis in oral squamous cell carcinoma: Where we are and where we are going","volume":"3","author":"Cao","year":"2023","journal-title":"Clin. Transl. Discov."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1159\/000534491","article-title":"Nodal metastasis in surgically treated oral cavity squamous cell carcinoma","volume":"85","author":"Carey","year":"2023","journal-title":"ORL"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"977","DOI":"10.4103\/jcrt.JCRT_783_20","article-title":"The predictive value of depth of invasion and tumor size on risk of neck node metastasis in squamous cell carcinoma of the oral cavity: A prospective study","volume":"18","author":"Jangir","year":"2022","journal-title":"J. Cancer Res. Ther."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1093\/ajcp\/aqaf066","article-title":"A comparative analysis of the significance of depth of invasion and tumor thickness in the staging of oral cavity squamous cell carcinoma","volume":"164","author":"Faraz","year":"2025","journal-title":"Am. J. Clin. Pathol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1511","DOI":"10.1007\/s12070-023-03637-0","article-title":"Depth of invasion, lymphovascular invasion, and perineural invasion as predictors of neck node metastasis in early oral cavity cancers","volume":"75","author":"Pandit","year":"2023","journal-title":"Indian J. Otolaryngol. Head Neck Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1055\/s-0041-1733348","article-title":"Patterns of neck nodal metastasis from oral cavity carcinoma","volume":"11","author":"Khunteta","year":"2022","journal-title":"South Asian J. Cancer"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"52","DOI":"10.4103\/jmms.jmms_200_24","article-title":"Correlation between tumor pathological characteristics and nodal metastasis in primary tumors in oral cavity cancers","volume":"28","author":"Malhotra","year":"2026","journal-title":"J. Mar. Med. Soc."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1177\/00034894231211116","article-title":"Role of lymphovascular invasion in oral cavity squamous cell carcinoma regional metastasis and prognosis","volume":"133","author":"Moore","year":"2024","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_14","first-page":"e496","article-title":"Perineural invasion predicts poor survival and cervical lymph node metastasis in oral squamous cell carcinoma","volume":"28","author":"Niklander","year":"2023","journal-title":"Med. Oral Patol. Oral Cir. Bucal"},{"key":"ref_15","first-page":"e40516","article-title":"Perineural invasion (PNI) definition, histopathological parameters of PNI in oral squamous cell carcinoma with molecular insight and prognostic significance","volume":"15","author":"Goswami","year":"2023","journal-title":"Cureus"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e808","DOI":"10.1016\/j.jormas.2022.07.005","article-title":"Impact of histological tumor grade on the behavior and prognosis of squamous cell carcinoma of the oral cavity","volume":"123","author":"Cariati","year":"2022","journal-title":"J. Stomatol. Oral Maxillofac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Wenzel, P.A., Van Meeteren, S.L., Pagedar, N.A., and Buchakjian, M.R. (2025). Perineural invasion and lymph node ratio quartile are associated with extranodal extension in oral cavity squamous cell carcinoma. J. Oral Maxillofac. Surg., Epub ahead of printing.","DOI":"10.1002\/oto2.70032"},{"key":"ref_18","first-page":"227","article-title":"Evaluation of histomorphological parameters to predict occult nodal metastasis in early-stage oral squamous cell carcinoma","volume":"38","author":"Verma","year":"2022","journal-title":"Turk. J. Pathol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1002\/lio2.790","article-title":"Prognostic value of pretreatment lymphocyte-to-monocyte ratio in patients with advanced oral cavity cancer","volume":"7","author":"Supanimitjaroenporn","year":"2022","journal-title":"Laryngoscope Investig. Otolaryngol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e227226","DOI":"10.1001\/jamanetworkopen.2022.7226","article-title":"Development and validation of machine learning models for predicting occult nodal metastasis in early-stage oral cavity squamous cell carcinoma","volume":"5","author":"Farrokhian","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Hassanzad, M., and Hajian-Tilaki, K. (2024). Methods of determining optimal cut-point of diagnostic biomarkers with application of clinical data in ROC analysis: An update review. BMC Med. Res. Methodol., 24.","DOI":"10.1186\/s12874-024-02198-2"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"16","DOI":"10.53346\/wjapls.2024.7.2.0039","article-title":"Comprehensive review of logistic regression techniques in predicting health outcomes and trends","volume":"7","author":"Olowe","year":"2024","journal-title":"World J. Adv. Pharm. 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