Which of the following is the MOST common site of occult (clinically node-negative) cervical metastasis that mandates elective neck dissection when treating oral tongue squamous cell carcinoma ≥4mm depth of invasion?

• A Level I (submental and submandibular)
• B Level III (middle jugular)
• C Level II (upper jugular) ✓
• D Level IV (lower jugular)

Explanation

Level II (upper jugular group, including jugulodigastric node) is the most common site of occult cervical metastasis from oral tongue squamous cell carcinoma, followed by Level I and III. Depth of invasion ≥4 mm is the threshold at which elective supraomohyoid neck dissection (levels I–III) is recommended due to the significant risk of occult nodal disease (>20%). Level IV skip metastases are rare from the oral tongue.

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.