Incidence of Occult Cervical Nodal Metastasis in Clinically N0 Buccal Squamous Cell Carcinoma

Background: The presence of occult cervical nodal metastasis in clinically N0 buccal squamous cell carcinoma (BSCC) poses a significant challenge in patient management and prognostication. This study aimed to determine the incidence of occult metastasis and to identify associated clinicopathological predictors to guide treatment decisions. Methods: A cross-sectional study was conducted on 48 patients with clinically N0 BSCC at Bangladesh Medical University (BMU). All patients underwent selective neck dissection, and histopathological features such as perineural invasion (PNI), lymphovascular invasion (LVI), and depth of invasion (DOI) were analyzed and correlated with pathological neck status. Results: A high incidence of occult nodal metastasis was observed, with 47.9% of patients having positive frozen section results and a high proportion showing pathological neck positivity (pN+). The presence of PNI and LVI was strongly associated with occult metastasis. A direct correlation was also found between greater DOI and a higher likelihood of pN+ status. Conclusion: This study demonstrates a high incidence of occult cervical nodal metastasis in clinically N0 buccal squamous cell carcinoma, highlighting the limitations of clinical staging alone. Histopathological features—particularly depth of invasion (DOI), perineural invasion (PNI), and lymphovascular invasion (LVI)emerge as strong predictors of occult nodal disease. The strong association between these markers and positive lymph nodes supports the selective use of neck dissection (SND) in high-risk patients. Optimizing patient selection for prophylactic neck dissection can maximize curative outcomes while minimizing unnecessary morbidity.