Skip to main content
SpringerLink
Log in

Rate of Occult Neck Nodal Metastasis in Parotid Cancer: A Meta-Analysis

  • Head and Neck Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The risk for occult neck nodal metastasis in carcinoma of the parotid gland is inconclusive. Therefore, addressing a negative neck prophylactically and the extent to do so remain controversial. This systematic review aimed to determine the rate of occult nodal metastasis for each neck level, and consequently, to elucidate the proper extent of elective neck dissection (END).

Methods

A meta-analysis of all studies that included patients with a diagnosis of parotid malignancies who underwent an END was performed. The risk for occult nodal metastasis was calculated for each neck level separately.

Results

The search strategy identified 124 papers from January 1980 to December 2019 in the various databases. Nine retrospective studies (n =548) met the inclusion criteria. The risk for occult neck nodal metastasis ranged from 0.0 to 9.43% with a random-effect model of 2.2% for level 1 (n =459), from 3.4 to 28.38% with a random-effect model of 16.51% for level 2 (n =548), from 0.0 to 21.63% with a random-effect model of 4.23% for level 3 (n =518), from 0.0 to 17.02% with a fixed-effect model of 0.39% for level 4 (n =310), and from 0.0 to 11.63% with a fixed-effect model of 1.7% for level 5 (n =417).

Conclusion

The rate of occult neck nodal metastasis in parotid malignancies is low, with neck level 2 the most commonly involved. The results of this meta-analysis prevented the authors from substantiating the appropriate extent of an END in parotid cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Nobis C-P, Rohleder NH, Wolff K-D, Wagenpfeil S, Scherer EQ, Kesting MR. Head and neck salivary gland carcinomas: elective neck dissection, yes or no? J Oral Maxillofac Surg. 2014;72:205–210.

    Article  Google Scholar 

  2. Gould EA, Winship T, Philbin PH, Kerr HH. Observations on a “sentinel node” in cancer of the parotid. Cancer. 1960;13:77–8.

    Article  CAS  Google Scholar 

  3. Armstrong JG, Harrison LB, Spiro RH, Fass DE, Strong EW, Fuks ZY. Malignant tumors of major salivary gland origin: a matched-pair analysis of the role of combined surgery and postoperative radiotherapy. Arch Otolaryngol Head Neck Surg. 1990;116:290–3.

    Article  CAS  Google Scholar 

  4. Kim BY, Hyeon J, Ryu G, et al. Diagnostic accuracy of fine-needle aspiration cytology for high-grade salivary gland tumors. Ann Surg Oncol. 2013;20:2380–7.

    Article  Google Scholar 

  5. Vartanian JG, Gonçalves Filho J, Kowalski LP, et al. An evidence-based analysis of the management of N0 neck in patients with cancer of the parotid gland. Expert Rev Anticancer Ther. 2019;19:899–908.

    Article  CAS  Google Scholar 

  6. Holsinger FC, Bui DT. Anatomy, function, and evaluation of the salivary glands. Salivary Gland Disorders: Springer; 2007:1–16.

  7. Yoo SH, Roh JL, Kim SO, et al. Patterns and treatment of neck metastases in patients with salivary gland cancers. J Surg Oncol. 2015;111:1000–6.

    Article  Google Scholar 

  8. Moher D, Shamseer L, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systemat Rev. 2015;4:1.

    Article  Google Scholar 

  9. Spitz MR, Batsakis JG. Major salivary gland carcinoma: descriptive epidemiology and survival of 498 patients. Arch Otolaryngol. 1984;110:45–9.

    Article  CAS  Google Scholar 

  10. Medina JE. Neck dissection in the treatment of cancer of major salivary glands. Otolaryngol Clin North Am. 1998;31:815–22.

    Article  CAS  Google Scholar 

  11. de Brito Santos IR, Kowalski LP, de Araujo VC, Logullo AF, Magrin J. Multivariate analysis of risk factors for neck metastases in surgically treated parotid carcinomas. Arch Otolaryngol Head Neck Surg. 2001;127:56–60.

    Article  Google Scholar 

  12. Zbären P, Schär C, Hotz MA, Loosli H. Value of fine-needle aspiration cytology of parotid gland masses. Laryngoscope. 2001;111:1989–92.

    Article  Google Scholar 

  13. Schmidt RL, Hall BJ, Wilson AR, Layfield LJ. A systematic review and meta-analysis of the diagnostic accuracy of fine-needle aspiration cytology for parotid gland lesions. Am J Clin Pathol. 2011;136:45–59.

    Article  Google Scholar 

  14. Spiro JD, Spiro RH. Cancer of the parotid gland: role of 7th nerve preservation. World J Surg. 2003;27:863–7.

    Article  Google Scholar 

  15. Magnano M, Fernando Gervasio C, Cravero L, et al. Treatment of malignant neoplasms of the parotid gland. Otolaryngol Head Neck Surg. 1999;121:627–32.

    Article  CAS  Google Scholar 

  16. Zbären P, Schüpbach J, Nuyens M, Stauffer E. Elective neck dissection versus observation in primary parotid carcinoma. Otolaryngol Head Neck Surg. 2005;132:387–91.

    Article  Google Scholar 

  17. Armstrong JG, Harrison LB, Thaler HT, et al. The indications for elective treatment of the neck in cancer of the major salivary glands. Cancer. 1992;69(3):615–619.

    Article  CAS  Google Scholar 

  18. Klussmann J, Ponert T, Mueller R, Dienes H, Guntinas-Lichius O. Patterns of lymph node spread and its influence on outcome in resectable parotid cancer. EJSO Eur J Surg Oncol. 2008;34:932–7.

    Article  CAS  Google Scholar 

  19. Lim CM, Gilbert M, Johnson JT, Kim S. Is level V neck dissection necessary in primary parotid cancer? Laryngoscope. 2015;125:118–21.

    Article  Google Scholar 

  20. Lau VH, Aouad R, Farwell DG, Donald PJ, Chen AM. Patterns of nodal involvement for clinically N0 salivary gland carcinoma: refining the role of elective neck irradiation. Head Neck. 2014;36:1435–9.

    Article  Google Scholar 

  21. Ali S, Palmer FL, DiLorenzo M, Shah JP, Patel SG, Ganly I. Treatment of the neck in carcinoma of the parotid gland. Ann Surg Oncol. 2014;21:3042–8.

    Article  Google Scholar 

  22. Stodulski D, Mikaszewski B, Majewska H, Wiśniewski P, Stankiewicz C. Probability and pattern of occult cervical lymph node metastases in primary parotid carcinoma. Eur Arch Oto-Rhino-Laryngol. 2017;274:1659–64.

    Article  Google Scholar 

  23. Weiss MH, Harrison LB, Isaacs RS. Use of decision analysis in planning a management strategy for the stage NO neck. Arch Otolaryngol Head Neck Surg. 1994;120:699–702.

    Article  CAS  Google Scholar 

  24. Wang YL, Li DS, Gan HL, et al. Predictive index for lymph node management of major salivary gland cancer. Laryngoscope. 2012;122:1497–506.

    Article  Google Scholar 

  25. Pan W, Ba K, Niu X, Liu F, Fang Q. Sentinel lymph node biopsy in cN0 neck management of parotid cancer. Sci Rep. 2019;9:8339.

    Article  Google Scholar 

  26. Chen AM, Garcia J, Lee NY, Bucci MK, Eisele DW. Patterns of nodal relapse after surgery and postoperative radiation therapy for carcinomas of the major and minor salivary glands: what is the role of elective neck irradiation? Int J Radiat Oncol Biol Phys. 2007;67:988–94.

    Article  Google Scholar 

  27. Ang KK, Trotti A, Brown BW, et al. Randomized trial addressing risk features and time factors of surgery plus radiotherapy in advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2001;51:571–8.

    Article  CAS  Google Scholar 

  28. Cho J-K, Lim B-W, Kim E-H, et al. Low-grade salivary gland cancers: treatment outcomes, extent of surgery, and indications for postoperative adjuvant radiation therapy. Ann Surg Oncol. 2016;23:4368–75.

    Article  Google Scholar 

  29. Kawata R, Yoshimura K, Lee K, Araki M, Takenaka H, Tsuji M. Basal cell adenoma of the parotid gland: a clinicopathological study of nine cases: basal cell adenoma versus pleomorphic adenoma and Warthin’s tumor. Eur Arch Oto-Rhino-Laryngol. 2010;267:779–83.

    Article  Google Scholar 

  30. Stenner M, Molls C, Luers JC, Beutner D, Klussmann JP, Huettenbrink K-B. Occurrence of lymph node metastasis in early-stage parotid gland cancer. Eur Arch Oto-Rhino-Laryngol. 2012;269:643–8.

    Article  Google Scholar 

  31. Shinomiya H, Otsuki N, Yamashita D, Nibu K-i. Patterns of lymph node metastasis of parotid cancer. Auris Nasus Larynx. 2016;43:446–50.

    Article  Google Scholar 

  32. Jinnin T, Kawata R, Higashino M, Nishikawa S, Terada T, Haginomori S-I. Patterns of lymph node metastasis and the management of neck dissection for parotid carcinomas: a single-institute experience. Int J Clin Oncol. 2019;24:624–31.

    Article  Google Scholar 

Download references

Author information

Author notes

  1. Anton Warshavsky and Roni Rosen have contributed equally.

Authors and Affiliations

  1. Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Affiliated With the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    Anton Warshavsky MD, Roni Rosen MD, Nidal Muhanna MD, PhD, Omer Ungar MD, Narin Nard-Carmel MD, MSc, Avraham Abergel MD, Dan M. Fliss MD & Gilad Horowitz MD

Authors
  1. Anton Warshavsky MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roni Rosen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nidal Muhanna MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Omer Ungar MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Narin Nard-Carmel MD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Avraham Abergel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dan M. Fliss MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Gilad Horowitz MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gilad Horowitz MD.

Ethics declarations

Disclosure

There are no conflicts of interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Warshavsky, A., Rosen, R., Muhanna, N. et al. Rate of Occult Neck Nodal Metastasis in Parotid Cancer: A Meta-Analysis. Ann Surg Oncol 28, 3664–3671 (2021). https://doi.org/10.1245/s10434-020-09331-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-020-09331-7

Search

Navigation