title: Compression Real-time Elastography for Evaluation of Salivary Gland Lesions: A Meta-analysis.
abstract: OBJECTIVE
  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 χ(2) and I(2) tests. I(2) > 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.
authors.affiliation: Department of Ultrasound, Southern Building, Chinese PLA General Hospital, Beijing, China.
authors.forename: Changtian
authors.initials: C
authors.lastname: Li
authors.affiliation: Department of Anesthesia and Operation Center, Chinese PLA General Hospital, Beijing, China.
authors.forename: Changsheng
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Ultrasound, Southern Building, Chinese PLA General Hospital, Beijing, China.
authors.forename: Nan
authors.initials: N
authors.lastname: Li
authors.affiliation: Department of Ultrasound, Southern Building, Chinese PLA General Hospital, Beijing, China li_jl@yeah.net.
authors.forename: Junlai
authors.initials: J
authors.lastname: Li
mesh_terms: D003937:Diagnosis, Differential; D054459:Elasticity Imaging Techniques / Q000379:methods*; D006801:Humans; D012372:ROC Curve; D015203:Reproducibility of Results; D012468:Salivary Gland Neoplasms / Q000000981:diagnostic imaging*; D012469:Salivary Glands / Q000000981:diagnostic imaging; D012680:Sensitivity and Specificity
keywords: diagnosis; head and neck ultrasound; meta-analysis; real-time elastography; salivary gland