Occult Nodal Metastases in Individuals with Clinically Node‐Negative Salivary Gland Malignancies

Objectives Salivary gland malignancies comprise a heterogeneous group of pathologies, for which treatment of the clinically negative neck may vary depending on numerous factors. Herein we present data on occult nodal metastases (ONM) as well as survival and recurrence from a large series of cN0 salivary gland malignancies. Methods Retrospective chart review was conducted on 532 patients, with 389 patients with major salivary gland cancers and 143 patients with minor salivary gland cancers. Demographic and treatment data were included and rates of ONM, overall survival, local recurrence, regional recurrence, and distant recurrence were analyzed. Results We found that the overall rate of ONM for parotid was 27% (63/235), for submandibular/sublingual was 35% (18/52), and for minor was 15% (4/26). Analysis of ONM rate at each nodal level was also performed, finding higher rates of level IV and V ONM than prior studies. Submandibular/sublingual and minor salivary gland malignancies showed a predominance of ONMs at levels I–III. Our survival and recurrence rates were similar to those found in previous studies. Conclusion Our data also demonstrate a predominance of ONM in levels I–III for submandibular/sublingual and minor salivary gland cancers, suggesting elective dissection in these levels. Level of Evidence 4 Laryngoscope, 134:1705–1715, 2024 To better guide decision‐making for treatment of occult nodal metastases (ONM) of cN0 salivary gland malignancies, we present ONM as well as survival and recurrence data from a large series of patients. Our higher rates of ONM in levels IV and V in parotid tumors suggest stronger consideration of elective dissection of these levels. Our data also support the practice of level I–III dissection in all but T1 submandibular cancers and only high grade minor salivary gland cancers.