Introduction
Materials and methods
Literature search
Database | Strategy |
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PubMed | (((((((("Parotid Neoplasms"[Mesh]) OR parotid neoplasm) OR parotid cancer) OR parotid carcinoma) OR parotid tumor) OR parotid mass) OR parotid lesion)) AND (((((((("Elasticity Imaging Techniques"[Mesh]) OR elasticity imaging technique) OR tissue elasticity imaging) OR elastography) OR vibro acoustography) OR acoustic radiation force impulse) OR sonoelastography) OR elastogram) |
Embase and Medline (Embase.com) | (#1) parotid AND neoplasm OR (parotid AND cancer) OR (parotid AND carcinoma) OR ( parotid AND tumor) OR (parotid AND mass) OR (parotid AND lesion) (#2) elasticity AND imaging AND technique OR (tissue AND elasticity AND imaging) OR elastography OR (vibro AND acoustography) OR (acoustic AND radiation AND force AND impulse) OR sonoelastography OR elastogram (#3) #1 AND #2 |
Cochrane Library | (#1) Mesh descriptor: [Parotid Neoplasms] explode all trees (#2) parotid neoplasm OR parotid cancer OR parotid carcinoma OR parotid tumor OR parotid mass OR parotid lesion (Word variations have been searched) (#3) #1 OR #2 (#4) Mesh descriptor: [Elasticity Imaging Techniques] explode all trees (#5) elasticity imaging technique OR tissue elasticity imaging OR elastography OR vibro acoustography OR acoustic radiation force impulse OR sonoelastography OR elastogram (Word variations have been searched) (#6) #4 OR #5 (#7) #3 AND #6 |
Web of Science | TOPIC: ((parotid neoplasm) OR (parotid cancer) OR (parotid carcinoma) OR (parotid tumor) OR (parotid mass) OR (parotid lesion)) AND TOPIC: ((elasticity imaging technique) OR (tissue elasticity imaging) OR (elastography) OR (vibro acoustography) OR (acoustic radiation force impulse) OR (sonoelastography) OR (elastogram)) |
OVID | (#1) (parotid neoplasm OR parotid cancer OR parotid carcinoma OR parotid tumor OR parotid mass OR parotid lesion).af. (#2) (elasticity imaging technique OR tissue elasticity imaging OR elastography OR vibro acoustography OR acoustic radiation force impulse OR sonoelastography OR elastogram).af. (#3) #1 AND #2 |
Inclusion and exclusion criteria
Data extraction
Quality assessment
Data analysis
Results
Literature search and characteristics of included studies
Author | Country | Year | Age (avg. or median) | Male/female | Number of patients | Number of lesions | Reference standard | Type of lesions (number of lesions) | Ultrasound system | Index of elastography | Cut-off value | TP | FP | FN | TN | |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | Klintworth et al [8] | Germany | 2012 | 53.3 | 27/30 | 57 | 57 | Postoperative pathology | Squamous cell carcinoma (3), mucoepidermoid carcinoma (1), salivary duct carcinoma (1), basal cell carcinoma (1), carcinoma ex pleomorphic adenoma (1), metastatic malignant melanoma (1); pleomorphic adenoma (22), Warthin tumour (20), cystadenoma (2), lipoma (2), cyst (3) | Siemens Ltd., Healthcare Sector, Acuson S2000 | Garland sign | Garland sign (+) | 3 | 2 | 5 | 47 |
2 | Yerli et al [24]* | Turkey | 2012 | 47.4 | 15/15 | 30 | 30 | Postoperative pathology (n = 33) or clinical indications, fine-needle aspiration biopsy (n = 3) | Adenocarcinomas (2), mucoepidermoid carcinomas (2), adenoid cystic carcinomas (1), malignant lymphoma (1); Warthin tumours (10), pleomorphic adenomas (10), lymphadenopathies (3), abscesses (1) | Hitachi Medical Systems, EUB-7000 | ES (4-point) | ES3 | 4 | 8 | 2 | 16 |
3 | Badea et al [16] | Romania | 2013 | NA | 15/5 | 20 | 20 | postoperative pathology | Parotid carcinomas (6), metastases (2); all pleomorphic adenomas (12) | General Electric GE 7, GE 8, GE 9; Phillips, iU22; Siemens S 2000 | Tactile Elastography or ARFI | NA | 8 | 6 | 0 | 6 |
4 | Celebi and Mahmutoglu [17] | Turkey | 2013 | 47.19 | 36/39 | 75 | 81 | Postoperative pathology (n = 73), FNAC (n = 6), both (n = 2) | Lymphoma (9), mucoepidermoid carcinoma (6), adenoid cystic carcinoma (5), metastases (3), myoepithelial malignant tumour (1), pleomorphic adenocarcinoma (2), salivary duct carcinoma (2), acinic cell carcinoma (2) and basal cell carcinoma (2); pleomorphic adenoma (28), Warthin tumour (10), lymphadenopathy (9), cystic adenoma/infected cyst rupture (2) | Siemens Medical Solutions, Siemens S2000 | CSES (4-point) | CSES3 | 19 | 19 | 13 | 30 |
5 | Wierzbicka et al [19] | Poland | 2013 | 54 | 27/16 | 43 | 43 | Postoperative pathology | Adenocarcinoma (3), malignant lymphoma (2), clear cell carcinoma (1), non-differentiated cancer (1), squamous cell cancer (1), cancer from pleomorphic adenoma (1) and salivary duct cancer (1); pleomorphic adenoma (23), Warthin tumour (5), monomorphic adenoma (2), neurofibroma (1), cyst (1), basal cell adenoma (1) | Supersonic Imagine, Aixplorer | ES (5-point) | ES4 | 4 | 1 | 6 | 32 |
6 | Yu et al [20] | China | 2016 | 45 | NA | 51 | 51 | Postoperative pathology | Mucoepidermoid carcinomas (5), acinic cell carcinomas (3), salivary duct carcinomas (3), basal cell carcinomas (2), adenoid cystic carcinoma (1), adenocarcinoma (1), carcinoma ex pleomorphic adenoma (1); pleomorphic adenoma (16), adenolymphomas (15), basal cell adenomas (2), multiple nodular acidophil adenoma (1), myoepithelioma (1) | Siemens Medical Solutions, Acuson S2000 | SWV | 2.76 m/s | 11 | 1 | 5 | 34 |
7 | Altinbas et al [15] | Turkey | 2017 | 60.01 | 26/20 | 46 | 54 | Fine-needle aspiration biopsy (cytological and histological results) | Malignant melanoma (3), salivary duct carcinoma (2), squamous cell carcinoma (1), adenoid cystic carcinoma (1), low-grade adenocarcinoma (1), mucoepidermoid carcinoma (1), Merkel cell carcinoma (1); Warthin tumour (18), pleomorphic adenoma (8), reactive lymphoid hyperplasia (6), lipoma (3), granulomatous inflammation (2), basal cell adenoma (2), lymphoepithelial cyst (1), sialadenitis and abscess (1), sialadenosis (1), primary benign oncocytic neoplasm (1), Rosai-Dorfman disease (1) | GE HealthCare, Logiq S7 Expert | E-index | 3 | 7 | 15 | 3 | 29 |
8 | Cantisani et al [7] | Italy | 2017 | 56 | NA | 63 | 63 | Postoperative pathology and FNAC | Mucoepidermoid carcinoma (5), malignant lymphoma (3), squamous cell carcinoma (2), acinic cell carcinoma (2), salivary duct carcinoma (2) and squamous cell carcinoma metastasis (2); pleomorphic adenoma (18), Warthin tumour (17), oncocytoma (5), lymphoepithelial cyst (3), ductal cyst (2), benign vascular tumour (2). | Samsung Medison, Accuvix A30, RS 80 A | ECI | 3.5 | 15 | 5 | 1 | 42 |
9 | Herman et al [6]* | Czech Republic | 2017 | 60 | 66/58 | 124 | 124 | Postoperative pathology | Squamous cell carcinoma (8), low grade salivary tumour (6), high grade salivary tumour (7), lymphoma (3), melanoma (2), sarcoma (1), neuroendocrine carcinoma (1); pleomorphic adenoma (49), Warthin tumour (33), other benign lesions (14) including oncocytic adenomas, lipomas, lipomatosis, basal cell adenoma, non-sebaceous lymphadenoma, branchiogenic cyst, and chronic inflammation | SuperSonic Imagine,Aixplorer | CSV | 1025 | 18 | 17 | 10 | 79 |
10 | Mansour et al [18]# | Germany | 2017 | 58.6 | NA | 202 | 202 | Postoperative pathology | Primary parotid carcinomas (10), secondary parotid carcinomas (13), non-Hodgkin lymphomas (9); pleomorphic adenomas (64), Warthin tumours (73), basal cell adenomas (6), oncocytomas (3), polymorphic adenomas (2), myoepithelioma (1), sebaceous lymphadenoma (1), ductal dilatations (8), lymphoepithelial cysts (5), cystadenomas (4), chronic inflammations (3) | Siemens Healthcare, Acuson S2000 | ES (3-point) | ES2 | 22 | 126 | 10 | 44 |
Quality assessment
QUADAS questionnaire | Klintworth et al 2012 [8] | Yerli et al 2012 [24] | Badea et al 2013 [16] | Celebi and Mahmutoglu 2013 [17] | Wierzbicka et al 2013 [19] | Yu et al 2016 [20] | Altinbas et al 2017 [15] | Cantisani et al 2017 [7] | Herman et al 2017 [6] | Mansour et al 2017 [18] |
---|---|---|---|---|---|---|---|---|---|---|
1: Was the spectrum of patient representative of the patients who will receive the test in practice? | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
2: Were selection criteria clearly described? | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
3: Is the reference standard likely to correctly classify the target condition? | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
4: Is the time period between reference standard and index test short enough to be sure that the target condition did not change between the two tests? | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
5: Did the whole sample, or a random selection of the sample, receive verification using a reference standard of diagnosis? | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
6: Did patients receive the same reference standard regardless of the index test result? | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
7: Was the reference standard independent of the index test (i.e., the index test did not form part of the reference standard)? | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
8: Was the execution of the index test described in sufficient detail to permit replication of the test? | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
9: Was the execution of the reference standard described in sufficient detail to permit replication? | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
10: Were the index test results interpreted without knowledge of the results of the reference standard? | No | Yes | Yes | Yes | Yes | Unclear | Yes | Yes | Yes | Yes |
11: Were the reference standard results interpreted without knowledge of the results of the index test? | Unclear | Unclear | Unclear | Unclear | Unclear | Unclear | Unclear | Unclear | Unclear | Unclear |
12: Were the same clinical data available when test results were interpreted as would be available when the test is used in practice? | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
13: Were un-interpretable/intermediate test results reported? | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
14: Were withdrawals from the study explained? | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
QUADAS score | 12.5 | 13.5 | 12.5 | 13.5 | 13.5 | 13 | 13.5 | 13.5 | 13.5 | 13.5 |
Diagnostic accuracy for differential diagnosis between malignant and benign parotid lesions
Heterogeneity results
Subgroup | Number of studies | Pooled sensitivity (95% CI) | Pooled specificity (95% CI) | Pooled DOR (95% CI) | AUC | p value |
---|---|---|---|---|---|---|
Mechanism | 0.119 | |||||
SWE | 6 | 0.61 (0.52–0.70) | 0.62 (0.57–0.66) | 6.39 (1.82–22.35) | 0.67 | |
SE | 3 | 0.81 (0.64–0.93) | 0.76 (0.67–0.83) | 11.67 (1.56–87.41) | 0.64 | |
SWE technique | 0.473 | |||||
ARFI | 4 | 0.63 (0.52–0.73) | 0.51 (0.45–0.57) | 4.91 (0.96–25.05) | 0.65 | |
SSI | 2 | 0.58 (0.41–0.74) | 0.86 (0.79–0.92) | 9.50 (3.99–22.63) | NA | |
Assessment method | 0.035* | |||||
Qualitative | 5 | 0.59 (0.48–0.69) | 0.52 (0.46–0.58) | 3.38 (1.08–10.57) | 0.63 | |
Qualitative or semiquantitative | 4 | 0.73 (0.61–0.83) | 0.83 (0.77–0.88) | 18.64 (4.51–77.07) | 0.88 | |
QUADAS score | 0.462 | |||||
13.5 | 7 | 0.66 (0.58–0.74) | 0.59 (0.54–0.63) | 5.41 (1.81–16.13) | 0.74 | |
≤ 13 | 3 | 0.69 (0.50–0.84) | 0.91 (0.83–0.96) | 26.56 (6.91–102.11) | 0.90 |