Salivary Gland Malignancy

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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)

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