Select dissection.

Paragangliomas are deemed “malignant” if and only if they have already metastasized. Apparently, there’s just no good way to otherwise categorize malignant potential with path alone. This single institution retrospective look at paragangliomas spanning over half a century reports 17 of 70, or roughly one-quarter, were found to have metastatic disease. Most interesting, almost all metastatic disease in the head and neck was discovered only upon elective nodal sampling with a selective neck dissection. | McCrary, JAMA Otolaryngol Head Neck Surg 2019