Surgical treatment of the neck in patients with salivary gland carcinoma

Topography and probability diagram of cervical and intra-parotid lymph node metastasis in parotid gland cancer

In parotid gland cancer (PGC), cervical lymph node metastasis (LNM) and intra-parotid LNM are known as significant indicators of poor prognosis. However, the topography of LNM in the affected parotid gland and the lymphatic progression of PGC has never been explored in detail. This was a retrospective analysis of data from 423 patients with previously untreated primary PGC (2005 to 2020), excluding patients with squamous cell carcinoma, lymphoma or metastatic disease in the parotid gland. The pattern of LNM was analyzed by neck sub-level and parotid sub-site. Using the conditional probability of neck level involvement, a probability diagram was plotted on several thresholds to visualize the sequential progression of LNM in PGC. The pattern of LNM progression was found to be similar between low- and high-grade pathology, but the incidence differed significantly (8.0% vs. 45.4%). Intra-parotid LNs and level IIa LNs were the most common sites (57.3% and 61.0%) of LNM in PGC, followed by level III (31.7%), Ib (25.6%), IV (22.0%), IIb (20.7%) and Va (20.7%) LNM. In intra-parotid LNs, the incidence of LNM in the deep parotid LNs was relatively low (9.4%); most intra-parotid LNMs were observed in the superficial parotid (90.6%) and peri-tumoral (in contact with the tumor) (31.3%) LNs. LNM to levels Ia, Vb and contra-lateral LNM occurred only in the very late stage. Our results provide detailed information about LNM progression in PGC at the sub-level and can help clinicians decide the treatment extent, including surgery or radiation.

The evolving landscape of salivary gland tumors

Salivary gland cancers are a rare, histologically diverse group of tumors. They range from indolent to aggressive and can cause significant morbidity and mortality. Surgical resection remains the mainstay of treatment, but radiation and systemic therapy are also critical parts of the care paradigm. Given the rarity and heterogeneity of these cancers, they are best managed in a multidisciplinary program. In this review, the authors highlight standards of care as well as exciting new research for salivary gland cancers that will strive for better patient outcomes.

Incidence and spread pattern of lymph node metastasis from submandibular gland cancer

OBJECTIVES

To clarify the indication of neck dissection (ND) for patient with submandibular gland (SMG) cancer.

METHODS

A total of 43 patients with SMG cancer were retrospectively analyzed. Forty-one patients underwent ND: Levels I-V in 19 patients, Levels I-III in 18 patients, and Level Ib in 4 patients. The other two patients did not undergo ND, since preoperative diagnoses were benign. Postoperative radiotherapy was performed in 19 patients with positive surgical margin, high grade cancer or stage IV disease.

RESULTS

LN metastases were pathologically confirmed in all patients with cN + and 6 out of 31 patients with cN-. No patients developed regional recurrence during follow-up periods. Ultimately, LN metastases were pathologically confirmed in 17 of 27 high grade, one out of 9 intermediate grade, but not in 7 low grade.

CONCLUSIONS

Prophylactic neck dissection should be considered in T3/4 and high grade SMG cancers.

Diagnosis and Management of Parotid Gland Cancer with Focus on the Role of Preoperative Fine-Needle Aspiration Cytology: A 10-Year-Long Retrospective Study with 5-Year Follow-Up

Introduction

Salivary gland cancers represent a rare heterogeneous group of neoplasms with complex clinicopathological characteristics and distinct biological behaviour. The appropriate diagnosis and management of parotid gland cancer are challenging and should be based on the clinical, imaging, cytological, and histological features. The present study analysed the use of preoperative fine-needle aspiration cytology (FNAC) and intraoperative frozen section (FS) to guide the appropriate surgical and postoperative treatment of parotid gland cancers.

Materials and Methods

We selected 48 patients with primary malignancy of the parotid gland surgically treated between 1 January 2008 and 30 June 2017 at the Maxillo-Facial Surgery Division, University Hospital of Parma, Italy. The patients had postoperative histological diagnosis of malignant parotid cancer and were followed up for longer than 5 years.

Results

The 48 patients included in this study had a mean age of 56.7 years. The most frequent type of parotid gland cancer was carcinoma ex pleomorphic adenoma (22.9%), followed by mucoepidermoid carcinoma (16.7%) and acinic cell carcinoma (14.6%). All 48 patients underwent preoperative FNAC: 29 (60.4%) and 19 (39.6%) were suggestive of malignant and benign lesions, respectively. In 31 patients, intraoperative FS was performed.

Discussion

Compared to previous studies, the present study showed significantly lower diagnostic sensitivity of FNAC for parotid gland cancers. The preoperative diagnostic accuracy for suspected malignant cases may be improved by repeat analysis of the cytological specimen by experts, preoperative core needle biopsy, and/or intraoperative FS analysis of the suspected mass.

A Rare Case of Pleomorphic Adenoma in the Internal Auditory Canal

Pleomorphic adenoma is a common tumor of the salivary gland tumor, but it is rare in the ear. To the authors' knowledge, this patient is the first reported case of pleomorphic adenoma arising in the internal auditory canal. There have been few documents reporting the manifestations and the therapy strategy of this disease. This study clearly demonstrated the experience in treating pleomorphic adenoma, including the characteristics of the clinical manifestation, the key procedures of surgery, and key points of the diagnosis. The translabyrinthine approach under the microscope performed to remove this tumor is a good option for resecting this type of tumor.

Elective Neck Dissection Improves Regional Control in cN0 Minor Salivary Gland Carcinoma in the Oral Cavity

PURPOSE

Consensus regarding whether elective neck dissection (END) provides better outcomes than observation in clinically node negative minor salivary gland (MSG) carcinoma is lacking. Therefore, this study aimed to compare the impact of END with that of observation on regional control (RC) and overall survival (OS) and to detect the predictors for lymph-node metastasis in oral MSG carcinoma.

PATIENTS AND METHODS

A single-institution, retrospective cohort study was designed; it included patients with clinically node negative oral MSG carcinoma treated at a tertiary teaching hospital between January 2002 and January 2022. The primary predictor variable was END and primary outcome variables were RC and OS. The secondary outcome variable was lymph-node metastasis. Other covariates included demographic and pathologic features, TNM stage, and adjuvant treatment. The Kaplan-Meier method and Cox proportional hazards model were used to determine the effect of END on RC and OS. The chi-squared test and logistic regression models were used to identify independent predictors for lymph-node metastasis.

RESULTS

A total of 268 patients (107 men and 161 women) with a mean age of 46.4 ± 15.5 years were included. The 5-year RC rate was statistically different between the observation and END groups (75%; 95% confidence interval [CI], 67%-83; 95% CI, 81%-93%, respectively; P = .014). Cox regression analysis confirmed that END (hazard ratio [HR] 2.395; 95% CI: 1.433-8.275; P = .034) was independently associated with a decreased risk of regional recurrence. The 5-year OS rates for the observation and END groups were 66% (95% CI, 56-76%) and 76% (95% CI, 66-86%), respectively, and the difference was not statistical (P = .057). Occult metastasis occurred in 24.6% of patients. Primary tumor location on the tongue/floor of the mouth (odds ratio [OR], 4.287; 95% CI, 1.773-9.125; P = .011), T3/4 stage (OR, 3.286; 95% CI, 1.228-8.253; P = .021), and high-grade disease (OR, 6.674; 95% CI, 2.199-14.326; P < .001) were independently associated with an increased risk of occult metastasis.

CONCLUSIONS

RC was better with END than with observation, but OS was comparable with the two approaches. Primary tumor location on tongue/floor of the mouth, T3/4 stage, and high-grade disease were associated with an increased risk of lymph-node metastasis.