Lymph Node Yield as A Quality Metric in the Treatment of Oral Cavity Squamous Cell Carcinoma: The Need for Centre‐Specific Thresholds

Background Heterogeneity in surgeons' and pathologists' technique poses challenges in determining a universal lymph node yield (LNY) cut‐off as a quality metric for oral squamous cell carcinoma (OSCC) patients undergoing neck dissection. Methods OSCC patients from two head and neck centres were included. LNY cut‐offs were evaluated using survival outcomes. Pathology techniques for neck dissection specimens were analyzed, comparing step serial sectioning (SSS) with inspection and palpation. Results A total of 809 patients were analyzed. Mean LNY differed significantly between centres and between pathology techniques, with SSS demonstrating the highest mean LNY. Higher LNY with SSS technique was paradoxically associated with worse survival, and reliable LNY cut‐offs could not be established, while conventional pathological assessment with inspection and palpation showed greater consistency in defining LNY thresholds. Conclusions LNY and its cut‐off as a quality metric appear to be dependent on centre‐specific variables. SSS appears inconsistent in determining LNY cut‐off for optimal survival outcomes.