Intermediate Grade Salivary Gland Mucoepidermoid Carcinoma: Is Neck Dissection Indicated?

Area of Science:

• Otolaryngology
• Head and Neck Surgery
• Oncology

Background:

• NCCN guidelines recommend neck dissection for high-grade mucoepidermoid carcinoma (MEC) and observation for low-grade MEC.
• No specific guidelines exist for intermediate-grade MEC with clinically N0 neck.
• Management of intermediate-grade MEC with clinically uninvolved lymph nodes remains controversial.

Purpose of the Study:

• To evaluate the risk of lymphatic metastases in intermediate-grade MEC with clinically N0 neck.
• To inform clinical decision-making regarding elective neck dissection for this patient group.

Main Methods:

• Retrospective analysis of patients with intermediate-grade MEC and clinically N0 neck from 2015-2023.
• Evaluation of histologic lymphatic metastases in patients undergoing neck dissection.
• Review of clinical observation outcomes and regional lymphatic recurrence in patients not undergoing neck dissection.

Main Results:

• Thirty-five patients with N0 intermediate-grade MEC were analyzed.
• One of 26 patients (3.8%) who underwent neck dissection had positive lymph nodes.
• No recurrence was observed in 9 patients managed with watchful waiting (mean follow-up 40 months).
• Overall documented metastatic disease was 2.9%.

Conclusions:

• The risk of lymphatic metastases in intermediate-grade MEC with a clinically N0 neck is low (2.9%).
• The potential morbidity of elective neck dissection may outweigh the benefits in this low-risk group.
• A selective approach to lymphadenectomy, considering lesion behavior, is suggested for intermediate-grade MEC.