Compression Real-time Elastography for Evaluation of Salivary Gland Lesions: A Meta-analysis

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Abstract

Objectives

To evaluate the performance of compression real-time elastography for differentiation between benign and malignant salivary gland lesions.

Methods

A systematic literature database search was conducted. Pooled sensitivity, specificity, positive likelihood ratio (LR+), and negative likelihood ratio (LR−) values for real-time elastography were analyzed. Summary receiver operating characteristic (ROC) curves were also constructed. Heterogeneity was evaluated by χ2 and I2 tests. I2 > 50% or P < .05 indicated heterogeneity, and then a random-effects model was applied. A Deek funnel plot was used to assess publication bias. Fagan plot analysis was performed to evaluate the clinical utility of real-time elastography. When heterogeneity was found, subgroup analyses were used to explore the sources of heterogeneity. A sensitivity analysis was conducted by omitting 1 study at a time and examining the influence of each individual study on the overall results.

Results

Nine articles with 581 lesions were included. The pooled sensitivity and specificity of real-time elastography for differentiation between benign and malignant lesions were 76% (95% confidence interval [CI], 65%–85%; 95% prediction interval [PI], 29%–95%) and 73% (95% CI, 62%–81%; 95% PI, 24%–96%), respectively. The LR+ and LR− were 2.81 (95% CI, 1.79–4.39; 95% PI, 0.65–12.16) and 0.33 (95% CI, 0.20–0.55; 95% PI, 0.07–1.69). The area under the ROC curve was 0.81 (95% CI, 0.77–0.84). No publication bias was detected, according to the Deek funnel plot (P = .51). The Fagan plot showed that when pretest probabilities were 25%, 50%, and 75%, positive posttest probabilities were 48%, 74%, and 89%, and negative probabilities were 10%, 25%, and 50%.

Conclusions

Real-time elastography is a novel supplementary adjunct to conventional sonography for evaluation of salivary gland lesions. However, its overall accuracy is less promising, and biopsy may still be necessary in routine clinical practice.

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