Role of Sonoelastography in Differentiating Benign and Malignant Salivary Gland Tumors: A Systematic Review and Meta Analysis

Objective: The goal of this systematic review is to determine the diagnostic accuracy of sonoelastography in evaluating salivary gland tumors. Data sources: A highly sensitive search for sonoelastography and salivary gland tumors was performed through MEDLINE, Cochrane Library, ACP Journal Club, EMBASE, Health Technology assessment, and ISI web of knowledge for studies published prior to January 2013. A manual search was performed to include additional studies from references of the retrieved articles. Review methods: Two independent reviewers evaluated articles for eligibility. They extracted data from included studies. The quality of included studies was evaluated by use of Quality Assessment of Diagnostic Accuracy Studies (QUADAS) questionnaire which consists of 14, four option questions (yes, no, unclear, Not Applicable (N/A)). Forest plots for pooled estimates and summery of ROC plots for different cut-offs were produced. Results: The literature review and manual search yielded 15 articles, 6 of which eligible to be included. A total of 348 individuals with total number of 366 salivary gland masses were evaluated. Eighty seven were malignant while, 269 were benign. Three hundred and twenty two were located in parotid gland and forty four were in sub-mandibular gland. The summary sensitivity and specificity for the differentiation of benign and malignant salivary gland masses were 0.63 and 0.59.The summary Diagnostic OR (D OR), positive and negative LRs were 3.18, 1.63 and 0.61. The Area Under the Curve (AUC) was 0.68 (SE=0.03). Conclusion: Sono-elastography had moderate accuracy in differentiating benign from malignant salivary gland tumors.