Bhattacharyya and Fried identified factors predictive of lymph node metastases from a carcinoma or sarcoma arising in a major salivary gland. This can help to identify a patient who may benefit from a radical neck dissection. The authors are from Brigham & Women's Hospital and Albert Einstein College of Medicine.
Patient selection: major salivary gland carcinoma
Predictors of lymph node metastases:
(1) older age (mean age 58.3 years with standard deviation 17.9 years; will use > 65 years in the implementation)
(2) histopathologic type
(3) facial nerve involvement
(4) extraglandular spread
(5) tumor grade
(6) tumor size (odds ratio increases two-fold if tumor 5 cm in diameter)
Tumors were graded from well-differentiated (Grade 1) to undifferentiated (Grade 4). The odds ratios doubled for each increase in grade.
Tumors most likely to metastasize to lymph nodes: squamous cell carcinoma or adenocarcinoma
Tumors least likely to metastasize to lymph node: adenoid cystic carcinoma, adenosquamous carcinoma or sarcoma
The presence of lymph node metastases is associated with a significant decrease in survival. A patient with risk factors for metastasis may be candidate for a radical neck dissection. The presence of lymph node metastases can help to identify a patient who may benefit from more aggressive management.
While not listed by the authors, palpable lymph nodes and suggestive findings on imaging studies would also seem to be indications.
