Patterns of lymph node metastasis and the management of neck dissection for parotid carcinomas: a single-institute experience

Jinnin, Tsuyoshi; Kawata, Ryo; Higashino, Masaaki; Nishikawa, Shuji; Takato, Tsuyoshi; Haginomori, Shin‐Ichi

doi:10.1007/s10147-019-01411-3

Cited by 23 publications

(37 citation statements)

References 20 publications

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“…4,5 Still, in spite of its widespread use, as of a few years ago, there was no internationally accepted system for the reporting of salivary gland cytopathology. 4,5 Still, in spite of its widespread use, as of a few years ago, there was no internationally accepted system for the reporting of salivary gland cytopathology.…”

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confidence: 99%

“…in patients with malignant ones. 4,5 Still, in spite of its widespread use, as of a few years ago, there was no internationally accepted system for the reporting of salivary gland cytopathology. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) was established with the goal of creating a practical standardized reporting system for the reporting salivary gland FNA.…”

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confidence: 99%

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The Milan System at Memorial Sloan Kettering: Utility of the categorization system for in‐house salivary gland fine‐needle aspiration cytology at a comprehensive cancer center

Lubin

Buonocore

Wei

et al. 2019

Diagnostic Cytopathology

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Background: The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) provides a standardized reporting system for salivary gland fine-needle aspiration (SGFNA). We review the clinical utility of the MSRSGC at a tertiary care cancer center by assessing the rates of malignancy (ROM) among different categories.Methods: A retrospective search was performed to retrieve all SGFNA cases performed at our institution between 1/1/07 and 12/31/18. The initial primary diagnoses were recorded and cases were then assigned to appropriate MSRSGC categories. ROM was then calculated for all categories.Results: A total of 976 cases were identified, and 373 with follow-up. The ROM was 19.7% (192/976) for all-comers and 51.3% (192/374) among cases with follow-up.Using MSRSGC, SGFNA showed a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 65.6%, 87.4%, 100%, and 72.6%, respectively. ROM for MSRSGC categories I, II, III, IVa, IVb, V, and VI were 20.7%, 30.0%, 45.8%, 3.3%, 50.7%, 100%, and 100%, respectively. Utilizing MSRSGC resulted in a nondiagnostic rate of 14.4%. The nondiagnostic rate was lower when the procedure was performed by pathologists vs nonpathologists (12.9% vs 15.8%) but was comparable when rapid on site evaluation (ROSE) was performed (12.9% vs 11.6%).Conclusion: In our patient population, MSRSGC resulted in a perfect PPV and moderate NPV. Utilizing MSRSGC results in a higher nondiagnostic rate due to the inclusion of cases with benign elements or cyst contents only in this category. Performing ROSE is more important in attaining an adequate sample than the specialty of the person performing SGFNA. K E Y W O R D Sfine-needle aspiration, Milan system for reporting salivary gland cytopathology, salivary gland

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confidence: 99%

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confidence: 99%

The Milan System at Memorial Sloan Kettering: Utility of the categorization system for in‐house salivary gland fine‐needle aspiration cytology at a comprehensive cancer center

Lubin

Buonocore

Wei

et al. 2019

Diagnostic Cytopathology

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“…Achieving a consensus on guidelines for END in patients with cN0 is more difficult. Studies have found occult metastases in 6%–45% of patients with salivary gland carcinomas 4,8,12,14,15,17,20,21,23,26,27,30,37‐47 . We found occult metastases in 14% of patients who had been treated with END.…”

Section: Discussionmentioning

confidence: 44%

“…Several studies have reported a high frequency of occult metastases among patients with adenoid cystic carcinoma, 37,49,50 whereas other studies have reported the highest rates of occult metastases among patients with adenocarcinoma, mucoepidermoid carcinoma, undifferentiated carcinoma, squamous cell carcinoma, and salivary duct carcinoma 8,17,26,27 . Some studies recommend an individual assessment for END in patients with cN0, 38‐40,51 whereas other studies recommend END for all patients with high‐grade histology or T3/T4 tumors 8,14,15,17,20,21,45 . Several studies recommend END for all patients with salivary gland carcinomas, 22,23,25 because preoperative diagnoses are inaccurate and occult metastases may occur in low‐grade as well as high‐grade histological subtypes.…”

Section: Discussionmentioning

confidence: 99%

“…Current practice in Denmark is TND in patients with clinically positive cervical lymph nodes, and elective neck dissection (END) is recommended in patients with T3/T4 tumors, high‐grade histology tumors, or in cases of facial nerve palsy 13 . This approach is supported by studies that recommend END in patients with high‐grade histology tumors or advanced tumor classifications 8,11,12,14‐21 . Other studies have recommended END in all patients with salivary gland carcinomas, 22‐26 because preoperative evaluations of histological tumor subtypes and grades are unreliable and there is a risk of regional metastases even for low‐grade histology tumors.…”

Section: Introductionmentioning

confidence: 99%

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Surgical treatment of the neck in patients with salivary gland carcinoma

et al. 2021

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Background Elective neck dissection (END) in patients with salivary gland carcinoma is controversial and there are no universally accepted guidelines. Methods Patients were identified from the Danish Head and Neck Cancer Group. Between 2006 and 2015, 259 patients with primary salivary gland carcinoma were treated with END. Variables potentially associated with regional metastases were analyzed using logistic regression. Neck recurrence‐free survival was calculated using the Kaplan–Meier method. Results Occult metastases were found in 36 of the patients treated with END (14%) and were particularly frequent among patients with T3/T4 tumors and high‐grade histology tumors. In multivariate analyses, high‐grade histology and vascular invasion were associated with occult metastases. Conclusion We recommend END of levels II and III for patients with high‐grade or unknown histological grade tumors, and for T3/T4 tumors. Levels I, II, and III should be included in END in patients with submandibular, sublingual, or minor salivary gland carcinomas.

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Elective neck dissection in salivary gland malignancies: Systematic review and meta‐analysis

et al. 2021

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We defined the occult nodal metastasis (ONM) rate of clinical node‐negative salivary gland malignancies and examined the role of elective neck dissection (END). Meta‐analysis querying four databases, from inception of databases to March 25th, 2020. Fifty‐one studies with 11 698 patients were included. ONM rates were 64% for salivary ductal carcinoma (SDC), 51% for undifferentiated carcinoma, 34% for carcinoma ex‐pleomorphic adenoma (CXPA), 32% for adenocarcinoma not otherwise specified (ANOS), 31% for lymphoepithelial carcinoma (LE), 20% for mucoepidermoid carcinoma, 17% for acinic cell carcinoma, and 17% for adenoid cystic carcinoma. T3/T4 tumors had a 2.3 times increased risk of ONM than T1/T2 tumors. High‐grade tumors had a 3.8 times increased risk of ONM than low/intermediate‐grade tumors. ONM rates were exceedingly high for T3/T4, high‐grade, and undifferentiated, SDC, ANOS, CXPA, and LE tumors, indicating the potential role of END.

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Patterns of lymph node metastasis and the management of neck dissection for parotid carcinomas: a single-institute experience

Cited by 23 publications

References 20 publications

The Milan System at Memorial Sloan Kettering: Utility of the categorization system for in‐house salivary gland fine‐needle aspiration cytology at a comprehensive cancer center

The Milan System at Memorial Sloan Kettering: Utility of the categorization system for in‐house salivary gland fine‐needle aspiration cytology at a comprehensive cancer center

Surgical treatment of the neck in patients with salivary gland carcinoma

Elective neck dissection in salivary gland malignancies: Systematic review and meta‐analysis

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