A 58-year-old male presents with a 3 cm squamous cell carcinoma of the right oral tongue with a clinically negative neck (cN0). Depth of invasion on MRI is 8 mm. What is the most appropriate management of the neck?
- A Ipsilateral selective neck dissection (levels I–III) ✓
- B Observation with sentinel node biopsy only
- C Bilateral radical neck dissection
- D PET-CT followed by observation if negative
Correct answer: A. Ipsilateral selective neck dissection (levels I–III)
Explanation
A depth of invasion (DOI) of ≥4 mm in oral tongue SCC is associated with >20% occult nodal metastasis, warranting elective neck dissection even in a clinically negative neck. Current guidelines (NCCN/AJCC 8th edition) recommend ipsilateral selective neck dissection (levels I–III for oral tongue) for DOI ≥4 mm. Radical neck dissection is not indicated for elective treatment of cN0. PET-CT has limited sensitivity for occult micrometastases in nodes <1 cm.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.