Can we now save the neck of OSCC T1–T2 patients? A narrative review of whether experimental techniques are on the way to clinical application

The molecular pathogenesis of oral squamous cell carcinoma (OSCC) is a complex process involving genetic alterations that accumulate over time. The clinical presentation and management of patients vary according to several pathological factors, but lymph node involvement is a key consideration in this context. Accurate lymph node staging in the neck is challenging because metastases may be present at an early stage of oral cancer. This narrative review assesses the evolution of imaging techniques over the last five years, distinguishing between research and established methods in order to address specific clinical questions. Conventional imaging techniques, including ultrasonography, contrast-enhanced computed tomography, contrast-enhanced magnetic resonance imaging and fluorine-18 fluorodeoxyglucose positron emission tomography, are reviewed and compared with several noteworthy developments in optical and fluorescence imaging. In this scenario, various position papers and guidelines strongly suggest using scintigraphy for sentinel node biopsy. However, its use in clinical practice is not widespread. This is a direct result of unrelenting advances in imaging accuracy, treatment options and new diagnostic approaches. All these approaches are considered here, but none emerges as a universal solution. Overall, no single technique currently emerges as a universal solution. The most realistic strategy is an integrated, multidisciplinary pathway. Multimodal imaging integration framework and AI-assisted diagnostic strategy could provide a novel clinical decision-making pathway for cervical lymph node staging in T1–T2 stage OSCC patients.