Current management of the neck in salivary gland carcinomas

Green, Ben; Rahimi, Siavash; Brennan, Peter A.

doi:10.1111/jop.12458

Cited by 24 publications

(17 citation statements)

References 66 publications

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“…Guidelines for the management of salivary gland tumours agree on neck management in the setting of clinically or radiologically positive cervical nodes, with either lymph node dissection or radical radiotherapy if the patient declines or is unfit 4,5 . However, indications for elective treatment of the neck in clinically node‐negative (cN0) patients remains a controversial topic with some advocating elective neck dissection (END), 6 others supporting elective neck irradiation (ENI), and some proposing observation of the cervical lymph nodes 7 .…”

Section: Introductionmentioning

confidence: 99%

Elective neck dissection in primary parotid carcinomas: A systematic review and meta‐analysis

Borsetto

Iocca

Boscolo‐Rizzo

et al. 2020

J Oral Pathology Medicine

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Background To estimate the rate of occult cervical lymph node metastases in cN0 patients affected by primary parotid carcinomas and to scrutinize the evidence on the indication and extent of elective neck dissection in these neoplasms. Methods Medline, Embase, Web of Science, Cochrane Library and Scopus were searched until August 31, 2020, to identify studies reporting the use of elective neck dissection in the management of malignant parotid tumours. The PRISMA checklist was used. A single arm meta‐analysis was then made to determine the pooled rate of occult lymph node metastases. Risk of bias of the included studies was assessed through the ROBINS‐E tool. Results The initial search returned 20 541 articles, of which twelve met the inclusion criteria and were included in the meta‐analysis. They comprised 1310 patients with parotid carcinoma, of whom 542 cN0 underwent elective neck dissection, which led to the diagnosis of lymph node metastasis (pN+/cN0) in 113 cases. Meta‐analysis of the results of elective neck dissection showed an overall rate of occult metastases of 0.22 (99% CI: 0.14‐0.30). Locally advanced or high‐grade tumours were the commonest indications for elective neck dissection in the included studies. The most dissected lymph node levels were I‐II‐III, and level II was the commonest site of occult nodal metastases. Conclusions An occult metastasis rate of 0.22 (99% CI: 0.14‐0.30) represents a not negligible percentage value, which should encourage further research to outline the most appropriate elective neck management in cN0 patients with parotid carcinomas.

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Section: Introductionmentioning

confidence: 99%

Elective neck dissection in primary parotid carcinomas: A systematic review and meta‐analysis

Borsetto

Iocca

Boscolo‐Rizzo

et al. 2020

J Oral Pathology Medicine

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“…Reviews carried out by Wang et al and Green et al [13, 14] attempted to identify the specific features of SGC, which could indicate the need for END. Among the reviewed studies, the two most common indicators for END were high-grade disease and locally advanced disease.…”

Section: Discussionmentioning

confidence: 99%

“…Among the reviewed studies, the two most common indicators for END were high-grade disease and locally advanced disease. Other studies suggest that the primary tumour site is also a key factor, with some authors mentioned in the review by Green et al stating that all patients with SGC – except for those with oral cavity tumours – should undergo prophylactic neck dissection [14]. The optimal management of these tumours remains controversial.…”

Section: Discussionmentioning

confidence: 99%

Management of clinically negative neck in salivary gland cancers – elective neck dissection, irradiation, or surveillance?

Szewczyk

Golusiński

Pazdrowski

et al. 2019

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Aim of the studyTo retrospectively assess treatment outcomes among patients treated for salivary gland cancers at our institution to determine which of the three most common treatment approaches – elective neck dissection (END), elective neck irradiation (ENI), or observation – provide the best results.Material and methodsA total of 122 patients were identified who had undergone primary surgery for SGC followed by END, ENI, or observation. The patients were classified into three groups according to the treatment approach used to manage the neck: END, ENI, or observation. The main outcome measures were disease-free survival (DFS) and overall survival (OS). We also sought to identify the risk factors potentially associated with neck metastasis and treatment failure.Results106 patients met all inclusion criteria. Of these 106 patients, 27 (25.7%) underwent END, 17 (16.0%) underwent ENI, and 62 (58.5%) observation. There were no statistically significant differences between the three groups in any of the following variables: advanced age (> 70); presence of locally advanced disease (T3 or T4); perineural invasion; lymphovascular invasion; and primary tumour location. Treatment failure was higher (non-significantly) in the END group (25.9%) vs. the observation (21.0%) and ENI (11.8%) groups. No differences (Kaplan-Meir curves) were observed among the three groups in terms of DFS or OS.ConclusionsOur results show that elective neck dissection does not appear to provide any benefit to patients treated for malignant salivary gland cancer. Importantly, these findings contradict most of the currently available research. However, due to methodological differences among the available studies, our findings cannot be compared directly to other studies.

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“…A majority of salivary gland tumors occurs in the parotid or submandibular glands facilitating pretreatment cytologic evaluation by palpation‐ or ultrasound‐guided fine needle aspiration (FNA) 2‐15 . The results of FNA interpretation can have significant implications for the clinical and surgical management of salivary gland lesions 6,16‐25 . Reactive and inflammatory conditions (eg, chronic sialadenitis, lymphoepithelial sialadenitis) are typically managed by clinical observation or treated medically.…”

Section: Introductionmentioning

confidence: 99%

“…Benign neoplasms such as Warthin tumor and pleomorphic adenoma are either excised by a conservative surgical approach or, in some cases, patients may opt for close clinical monitoring that may include occasional sampling by FNA. Low‐grade SGCs are usually treated with conservative resection with negative margins, while high‐grade SGCs are often managed by a more radical resection 16,18,22‐25 that may include neck dissection 16,19,23‐28 and facial nerve sacrifice pre‐ or intraoperatively 29 …”

Section: Introductionmentioning

confidence: 99%

Cytologic grading of primary malignant salivary gland tumors: A blinded review by an international panel

Johnson

Önenerk

Krane

et al. 2020

Cancer Cytopathology

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BACKGROUND: Fine needle aspiration (FNA) is commonly used for the preoperative evaluation of salivary gland tumors.Tumor grade is a key factor influencing clinical management of salivary gland carcinomas (SGCs). To assess the ability to grade nonbasaloid SGCs in FNA specimens, an international panel of cytopathologists convened to review and score SGC cases. METHODS: The study cohort included 61 cases of primary SGC from the pathology archives of 3 tertiary medical centers. Cases from 2005 to 2016 were selected, scanned, and digitized. Nineteen cytopathologists blinded to the histologic diagnosis reviewed the digitized cytology slides and graded them as low, high, or indeterminate. The panelists' results were then compared to the tumor grades based on histopathologic examination of the corresponding resection specimens. RESULTS:All but 2 of the 19 (89.5%) expert panelists review more than 20 salivary gland FNAs per year; 16 (84.2%) of the panelists work at academic medical centers, and 13 (68.4%) have more than 10 years' experience. Participants had an overall accuracy of 89.4% in the grading of SGC cases, with 90.2% and 88.3% for low-and high-grade SGC, respectively. Acinic cell carcinoma and mucoepidermoid carcinoma had the highest degree of accuracy, while epithelial-myoepithelial carcinoma and salivary duct carcinoma had the lowest degree of accuracy. As expected, the intermediate-grade SGC cases showed the greatest variability (high-grade, 42.1%; low-grade, 37.5%, indeterminate, 20.4%). CONCLUSION: This study confirms the high accuracy of cytomorphologic grading of primary SGC by FNA as low-or high-grade. However, caution should be exercised when a grade cannot be confidently assigned. Cancer Cytopathol 2020;128:392-402.

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Current management of the neck in salivary gland carcinomas

Cited by 24 publications

References 66 publications

Elective neck dissection in primary parotid carcinomas: A systematic review and meta‐analysis

Elective neck dissection in primary parotid carcinomas: A systematic review and meta‐analysis

Management of clinically negative neck in salivary gland cancers – elective neck dissection, irradiation, or surveillance?

Cytologic grading of primary malignant salivary gland tumors: A blinded review by an international panel

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