Staging neck dissection vs observation. As mentioned previously, staging neck dissection is generally recommended for low risk oral cavity cancers (T1,T2) without evidence of cervical metastases (N0). Some surgeons have advocated managing the neck expectantly, rather than therapeutically, and this clinical question remains a controversial topic. Numerous investigations studying this topic have adopted a “wait and see” approach. Neck surveillance is typically performed with serial ultrasound examinations. Some publications have noted a non-inferior outcome to elective neck dissection .
Sentinel lymph node biopsy (SLNB) for Oral cancer. Similar to the prior topic, the question has arisen whether the primary draining lymph node can be identified, sampled, and be considered as an indicator for disease in the neck. This is similar in approach to breast cancer – to identify the primary echelon draining lymph node as an indication of metastatic spread of the primary lesion. A large multi-center clinical trial has evaluated the efficacy of SLNB in early stage oral cavity cancer.  Results demonstrated a negative predictive value of 96%. Although the data is promising, adoption of SLNB for oral cancer in routine practice has been generally limited.
Role of PET scanning in the N0 neck. The role of PET/CT scan in accurately predicting the status of the neck remains controversial. Although PET/CT can frequently identify metabolically active lymph nodes which harbor disease, it has a low sensitivity and specificity. [9; 10] This is currently an ongoing clinical trial investigation. (www.acrin.org/6685_protocol.aspx)