title: Cervical lymph node metastasis in adenoid cystic carcinoma of oral cavity and oropharynx: A collective international review.
abstract: The purpose of this study was to suggest general guidelines in the management of the N0 neck of oral cavity and oropharyngeal adenoid cystic carcinoma (AdCC) in order to improve the survival of these patients and/or reduce the risk of neck recurrences. The incidence of cervical node metastasis at diagnosis of head and neck AdCC is variable, and ranges between 3% and 16%. Metastasis to the cervical lymph nodes of intraoral and oropharyngeal AdCC varies from 2% to 43%, with the lower rates pertaining to palatal AdCC and the higher rates to base of the tongue. Neck node recurrence may happen after treatment in 0-14% of AdCC, is highly dependent on the extent of the treatment and is very rare in patients who have been treated with therapeutic or elective neck dissections, or elective neck irradiation. Lymph node involvement with or without extracapsular extension in AdCC has been shown in most reports to be independently associated with decreased overall and cause-specific survival, probably because lymph node involvement is a risk factor for subsequent distant metastasis. The overall rate of occult neck metastasis in patients with head and neck AdCC ranges from 15% to 44%, but occult neck metastasis from oral cavity and/or oropharynx seems to occur more frequently than from other locations, such as the sinonasal tract and major salivary glands. Nevertheless, the benefit of elective neck dissection (END) in AdCC is not comparable to that of squamous cell carcinoma, because the main cause of failure is not related to neck or local recurrence, but rather, to distant failure. Therefore, END should be considered in patients with a cN0 neck with AdCC in some high risk oral and oropharyngeal locations when postoperative RT is not planned, or the rare AdCC-high grade transformation.
authors.affiliation: Instituto Universitario de Oncología del Principado de Asturias, Universidad de Oviedo, Oviedo, Spain; Fundación de Investigación e Innovación Biosanitaria del Principado de Asturias, Oviedo, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Suárez
authors.affiliation: Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Leon
authors.initials: L
authors.lastname: Barnes
authors.affiliation: Departments of Surgery and Otolaryngology - Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA.
authors.forename: Carl E
authors.initials: CE
authors.lastname: Silver
authors.affiliation: Instituto Universitario de Oncología del Principado de Asturias, Universidad de Oviedo, Oviedo, Spain; Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Juan P
authors.initials: JP
authors.lastname: Rodrigo
authors.affiliation: Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Jatin P
authors.initials: JP
authors.lastname: Shah
authors.affiliation: Oral and Maxillofacial Pathology, School of Dentistry, University of Liverpool and Cellular Pathology, Liverpool Clinical Laboratories, Liverpool, UK.
authors.forename: Asterios
authors.initials: A
authors.lastname: Triantafyllou
authors.affiliation: University of Udine School of Medicine, Udine, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Rinaldo
authors.affiliation: Department of Anatomic Pathology, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Cardesa
authors.affiliation: Department of Surgery, Banner MD Anderson Cancer Center, Gilbert, AZ, USA.
authors.forename: Karen T
authors.initials: KT
authors.lastname: Pitman
authors.affiliation: Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, São Paulo, Brazil.
authors.forename: Luiz P
authors.initials: LP
authors.lastname: Kowalski
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA.
authors.forename: K Thomas
authors.initials: KT
authors.lastname: Robbins
authors.affiliation: Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal.
authors.forename: Henrik
authors.initials: H
authors.lastname: Hellquist
authors.affiliation: Department of Otorhinolaryngology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
authors.forename: Jesus E
authors.initials: JE
authors.lastname: Medina
authors.affiliation: Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Remco
authors.initials: R
authors.lastname: de Bree
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Takes
authors.affiliation: Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Andrés
authors.initials: A
authors.lastname: Coca-Pelaz
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Nottingham University Hospitals, Queens Medical Centre Campus, Nottingham, UK; European Salivary Gland Society, Geneva, Switzerland.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Bradley
authors.affiliation: University Pathologists, Providence, RI, USA; University Pathologists, Fall River, MA, USA.
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Gnepp
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Philipp University, Marburg, Germany.
authors.forename: Afshin
authors.initials: A
authors.lastname: Teymoortash
authors.affiliation: Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia.
authors.forename: Primož
authors.initials: P
authors.lastname: Strojan
authors.affiliation: Department of Radiation Oncology, University of Florida, Gainesville, FL, USA.
authors.forename: William M
authors.initials: WM
authors.lastname: Mendenhall
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ, USA.
authors.forename: Jean Anderson
authors.initials: JA
authors.lastname: Eloy
authors.affiliation: Departments of Pathology and Otolaryngology-Head and Neck Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Justin A
authors.initials: JA
authors.lastname: Bishop
authors.affiliation: Department of Pathology, Allegiance Health, Jackson, MI, USA.
authors.forename: Kenneth O
authors.initials: KO
authors.lastname: Devaney
authors.affiliation: Consultant Pathologist, Southern California Permanente Medical Group, Woodland Hills, CA, USA.
authors.forename: Lester D R
authors.initials: LD
authors.lastname: Thompson
authors.affiliation: Department of Head and Neck Surgery, Head and Neck Oncology Program, St Luc University Hospital and King Albert II Cancer Institute, Brussels, Belgium.
authors.forename: Marc
authors.initials: M
authors.lastname: Hamoir
authors.affiliation: Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Pieter J
authors.initials: PJ
authors.lastname: Slootweg
authors.affiliation: European Salivary Gland Society, Geneva, Switzerland; Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven and KU Leuven, Department of Oncology, Section Head and Neck Oncology, Leuven, Belgium.
authors.forename: Vincent
authors.initials: V
authors.lastname: Vander Poorten
authors.affiliation: Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Michelle D
authors.initials: MD
authors.lastname: Williams
authors.affiliation: Department of Pathology, Beth Israel Medical Center, New York, NY, USA.
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Wenig
authors.affiliation: Department of Pathology, Charles University in Prague, Faculty of Medicine in Plzen, Plzen, Czech Republic.
authors.forename: Alena
authors.initials: A
authors.lastname: Skálová
authors.affiliation: Coordinator of the International Head and Neck Scientific Group. Electronic address: a.ferlito@uniud.it.
authors.forename: Alfio
authors.initials: A
authors.lastname: Ferlito
mesh_terms: D003528:Carcinoma, Adenoid Cystic / Q000473:pathology / Q000628:therapy*; D019468:Disease Management; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D009062:Mouth Neoplasms / Q000473:pathology / Q000628:therapy*; D009333:Neck; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local; D009959:Oropharyngeal Neoplasms / Q000473:pathology / Q000628:therapy*; D011878:Radiotherapy
keywords: Adenoid cystic; Carcinoma; Lymph nodes; Neck dissection; Recurrence; Risk factors