Serial Step Sectioning for Pathologically Node-Negative Oral Cancer: Echelon Node Evaluation and Failure Analysis for pN0 Patients

Elective neck dissection (END) has become a standard procedure in contemporary clinical practice for patients with node-negative oral cancer, offering a notable improvement in overall survival for early-stage disease. Despite advancements, the 5-year survival rate remains stable, and regional recurrence, albeit infrequent, poses a significant challenge.

This retrospective single-centre study aimed to evaluate the echelon node in patients with the pathologically node-negative disease who experienced regional and distant failures. Serial step sectioning (SSS) was utilized to identify occult metastasis features, including Isolated Tumor Cells (ITC) and micrometastases (miMets).

Clinical and pathological characteristics of 96 patients were analyzed, revealing significant associations between adverse pathological features like LVI, PNI, DOI, and nodal recurrence. While no micrometastases were detected in this analysis, further investigation with a larger cohort may be warranted.

The study underscores the importance of meticulous pathological assessment and the potential role of adjuvant therapy in mitigating recurrence risks in node-negative oral cancer patients. Additionally, it highlights the need for standardized reporting protocols and adequate lymph node yield in neck dissection procedures to optimize patient outcomes.