What is the role of elective neck dissection in low-, intermediate-, and high-grade mucoepidermoid carcinoma?

BACKGROUND The decision to proceed with elective neck dissection (END) is based on the probability of finding microscopic disease in a patient without clinical evidence of lymph node metastases. In contrast to squamous cell carcinoma of the head and neck, there is currently no standard of care for END in salivary gland carcinoma. This is due in large part to the relatively low incidence of these tumors and the diversity of histologic subtypes therein, many of which exhibit distinct tumor biology. Nevertheless, great progress has been made in recent decades in describing and predicting the behavior of salivary gland cancers. For mucoepidermoid carcinoma (MEC), the most common salivary gland malignancy, histologic tumor grade has emerged as the most important prognosticator for lymph node disease. However, in light of varying histologic grading criteria, technical difficulty in interpreting salivary gland histology, and a relative paucity of clinical data, there is no consensus on the reliability of tumor grade when considering elective treatment of the clinically negative (N0) neck in MEC patients.