Patient Counselling and Treatment Recommendations
Patients with the FNAB results concerning for salivary gland malignancy
and patients with confirmed salivary gland malignancies diagnosed after
an office-based or CT-guided biopsy should be counselled about the
prognosis and the need for surgical management despite of the surgical
case delays due to COVID-19 pandemic. It is important to discuss with
the patient the fact that salivary gland FNAB interpretation based on
MSRSGC has excellent, but variable reported sensitivity (86-100%) and
specificity (90-100%) in differentiating between benign and malignant
lesions.16 Unless the FNAB results are categorized as
“non-neoplastic” based on MSRSGC (Table 2),14surgical management should be discussed, while serious considerations
are given to higher risk of contracting COVID-19 and related
complications in cancer patients (Table 1).13,14
The current prevalence of COVID-19 positive patients in the geographic
area and within the hospital must be taken into account when discussing
surgery. Prior to any surgical intervention, patients should ideally
undergo COVID-19 testing. Clinicians must be aware of false negatives
with COVID-19 testing, and the fact that repeat testing for COVID-19 is
not feasible in most patients. Chest CT may be considered in select
cases for further evaluation and risk stratification to assess for signs
of COVID-19 related pulmonary involvement or
metastases.17 Surgery should be postponed for all
patients with suspicious chest CT findings, those with symptoms of
COVID-19 or positive COVID-19 test results.
When surgery is deemed necessary, surgical teams need to consider the
risk of aerosolization. For minor salivary gland tumors of the oral
cavity, sinonasal region and pharynx, appropriate PPE of the entire
operating room staff is highly recommended. Operating room personnel
must be minimized. For parotid and submandibular gland neoplasm
surgeries, the risk of aerosolized mucosal secretions is only
encountered during intubation and extubation. All non-essential
personnel should leave the room during intubation and extubation for
these surgeries, with appropriate PPE worn by all staff present in the
room.1
Management of obstructive salivary gland disease should be carried out
remotely in most cases. In rare cases, office-based evaluation and
treatment interventions or an intraoperative drainage and biopsy may be
required to rule out cancer, to manage an abscess or to relieve severe
pain not controlled after appropriate medical management. Sialendoscopy
should be avoided during the COVID-19 pandemic, given the irrigation and
the aerosolization.