Key Points
➤ Because salivary gland malignancies (SGMs) account for less than 5%
of all head and neck cancers, there are limited clinical trial data to help
guide therapy.
➤ Optimal treatment requires appropriate pathologic technique to
differentiate among the wide spectrum of histologies and the variety of
biological behaviors seen in SGMs.
Management
Preoperative Evaluation
➤ Providers should perform imaging (neck ultrasound, CT with IV contrast
and/or MRI of the neck and primary site) in patients with a suspicion of a
salivary gland cancer. (Strong recommendation; EB-I)
➤ Providers should perform computed tomography of the neck with
IV contrast for patients with suspicion for salivary gland cancer and
involvement of adjacent bone. (Strong recommendation; EB-I)
➤ Providers should perform contrast-enhanced MRI with a diffusion
sequence of the neck and skull base for patients with suspicion for
salivary gland cancer with concern for perineural invasion and/or skull
base involvement. (Strong recommendation; EB-I)
➤ Providers may perform a CT/positron emission tomography from the skull
base to mid-thighs for patients with advanced stage high-grade salivary
gland cancers. (Weak recommendation; EB-L)
➤ Providers should perform a tissue biopsy (either fine needle aspiration
biopsy or core needle biopsy) in order to support distinction of
salivary gland cancers from non-malignant salivary lesions. (Strong
recommendation; EB-H)
➤ Providers may perform core needle biopsy if fine needle aspiration biopsy
is inadequate or subsite precludes fine needle aspiration biopsy such as
deep minor salivary glands. (Moderate recommendation; EB-L)
➤ Pathologists should report risk of malignancy using a risk stratification
scheme for salivary fine needle aspiration biopsies with particular
attention to high-grade features. (Strong recommendation; EB-I)
➤ Pathologists may perform ancillary testing (immunohistochemical
or molecular studies) on fine needle aspiration biopsies and core
needle biopsies to support diagnosis and risk of malignancy. (Weak
recommendation; EB-L)