Cost Comparison of Sentinel Lymph Node Biopsy Versus Elective Neck Dissection in Early‐Stage Oral Cavity Squamous Cell Carcinoma

BACKGROUND: Elective neck dissection (END) is the standard treatment for early-stage oral cavity squamous cell carcinoma (OCSCC). This study compared costs of sentinel lymph node biopsy (SLNB) and END from the Medicare payer perspective. METHODS: Thirty-two patients with T1-2N0M0 OCSCC (16 SLNB and 16 END) treated at an academic institution from 2017 to 2025 were included. RESULTS: 32 patients were included: median age 62, 46.9% male, 38% had adjuvant RT. The SLNB cohort had shorter operative time and length-of-stay. Four patients had reoperations: 2 after SLNB (completion neck dissection, tumor re-resection) and 2 after END (neck hematomas). The SLNB cohort had lower costs for postoperative admission ($9567 vs. $12 920, p = 0.015). Total costs were not statistically different ($19 777 vs. $22 126, p = 0.45). On break-even analysis, SLNB with a completion ND rate ≤ 35% had lower costs than END. CONCLUSIONS: Costs of SLNB were 10.6% less than END, and remained lower with completion ND rates ≤ 35%.