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.

Consultant Pathologist Southern California Permanente Medical Group Woodland Hills CA USA

Coordinator of the International Head and Neck Scientific Group

Department of Anatomic Pathology Hospital Clinic University of Barcelona Barcelona Spain

Department of Biomedical Sciences and Medicine University of Algarve Faro Portugal

Department of Head and Neck Surgery and Otorhinolaryngology A C Camargo Cancer Center São Paulo Brazil

Department of Head and Neck Surgery Head and Neck Oncology Program St Luc University Hospital and King Albert 2 Cancer Institute Brussels Belgium

Department of Head and Neck Surgical Oncology UMC Utrecht Cancer Center University Medical Center Utrecht Utrecht The Netherlands

Department of Otolaryngology Head and Neck Surgery Neurological Institute of New Jersey Rutgers New Jersey Medical School Newark NJ USA

Department of Otolaryngology Head and Neck Surgery Nottingham University Hospitals Queens Medical Centre Campus Nottingham UK; European Salivary Gland Society Geneva Switzerland

Department of Otolaryngology Head and Neck Surgery Philipp University Marburg Germany

Department of Otolaryngology Head and Neck Surgery Radboud University Medical Center Nijmegen The Netherlands

Department of Otolaryngology Hospital Universitario Central de Asturias Oviedo Spain

Department of Otorhinolaryngology The University of Oklahoma Health Sciences Center Oklahoma City OK USA

Department of Pathology Allegiance Health Jackson MI USA

Department of Pathology Beth Israel Medical Center New York NY USA

Department of Pathology Charles University Prague Faculty of Medicine in Plzen Plzen Czech Republic

Department of Pathology Radboud University Medical Center Nijmegen The Netherlands

Department of Pathology The University of Texas MD Anderson Cancer Center Houston TX USA

Department of Pathology University of Pittsburgh School of Medicine Pittsburgh PA USA

Department of Radiation Oncology Institute of Oncology Ljubljana Slovenia

Department of Radiation Oncology University of Florida Gainesville FL USA

Department of Surgery Banner MD Anderson Cancer Center Gilbert AZ USA

Departments of Pathology and Otolaryngology Head and Neck Surgery The Johns Hopkins Medical Institutions Baltimore MD USA

Departments of Surgery and Otolaryngology Head and Neck Surgery Albert Einstein College of Medicine Montefiore Medical Center Bronx NY USA

Division of Otolaryngology Head and Neck Surgery Southern Illinois University School of Medicine Springfield IL USA

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

Head and Neck Surgery Memorial Sloan Kettering Cancer Center New York NY USA

Instituto Universitario de Oncología del Principado de Asturias Universidad de Oviedo Oviedo Spain; Department of Otolaryngology Hospital Universitario Central de Asturias Oviedo Spain

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

Oral and Maxillofacial Pathology School of Dentistry University of Liverpool and Cellular Pathology Liverpool Clinical Laboratories Liverpool UK

University of Udine School of Medicine Udine Italy

University Pathologists Providence RI USA; University Pathologists Fall River MA USA

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