Management of Salivary Gland Malignancy

1.1. Providers should perform imaging (neck ultrasound, computed tomography [CT] with intravenous contrast, and/or magnetic resonance imaging [MRI] of the neck and primary site) in patients with a suspicion of a salivary gland cancer. (EBIS)

1.2. Providers should perform CT of the neck with intravenous contrast for patients with suspicion of salivary gland cancer and involvement of adjacent bone. (EBIS)

1.3. Providers should perform contrast-enhanced MRI with a diffusion sequence of the neck and skull base for patients with suspicion of salivary gland cancer with concern for perineural invasion and/or skull base involvement. (EBIS)

1.4. Providers may perform a PET/CT from the skull base to mid-thighs for patients with advanced-stage high-grade salivary gland cancers. (EBLW)

1.5. Providers should perform a tissue biopsy (either fine needle aspiration biopsy [FNAB] or core needle biopsy [CNB]) to support distinction of salivary gland cancers from nonmalignant salivary lesions. (EBHS)

1.6. Providers may perform CNB if FNAB is inadequate or subsite precludes FNAB such as deep minor salivary glands. (EBLM)

1.7. Pathologists should report risk of malignancy using a risk stratification scheme for salivary FNABs with particular attention to high-grade features. (EBIS)

1.8. Pathologists may perform ancillary testing (immunohistochemical or molecular studies) on FNABs and core needle biopsies to support diagnosis and risk of malignancy. (EBLW)