Evaluation of a submandibular mass: Key points

50% are malignant
Adenoid cystic carcinoma is the most common malignancy
Clinical evaluation, cytology and imaging do not conclusively exclude malignancy….hence complete resection of the tumour and histological examination are required, or if surgery is not to be done, a core needle biopsy
Objectives of preoperative evaluation
- Distinguish between a submandibular lymph node and salivary mass
- Avoid unnecessary surgery
- Do appropriate surgery
- Avoid embarking on surgery that is beyond the scope of a surgeon e.g. tumour requiring neck dissection
History and examination are important means to identify non-neoplastic causes e.g. sialadenitis, sialolithiasis, and benign and malignant primary tumours, although 2/3 of malignant tumours are clinically benign
FNAC is helpful in selected cases
Ultrasound may distinguish a lymph node from a salivary mass, and identify cervical nodal metastases
Histological classification of primary salivary gland neoplasms is difficult and complex. Cytological and histological diagnoses should always be treated with caution and viewed in a clinical context, especially if not reported from centers of excellence