Controversies on the management of the clinically negative neck

Adequate management of the clinically negative neck is vital and should be balanced between over and undertreatment. Compared to clinical examination ultrasound-guided fine-needle aspiration cytology (USgFNAC) at initial staging can reduce the risk of occult metastases for T1-T2 squamous cell carcinoma of the oral cavity or oropharynx considerably to 20%, which justifies local excision of the tumour and a wait-and-see policy for the neck. SN identification and aspiration did not decrease the false-negative rate, and we have therefore abandoned its use in this setting. Using USgFNAC for follow-up enabled early detection of a significant percentage of neck failures and a high salvage rate with therapeutic neck dissection of 80%. Detecting subclinical neck metastases continues to challenge clinicians and debate continues.