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Title Ultrasound Can Be a Valuable Initial Assessment Tool in Detecting Major Salivary Gland Tumors
Clinical Question Can ultrasound provide a better diagnostic tool compared to MRI in detecting major salivary gland tumors (SGTs)?
Clinical Bottom Line Ultrasound can be a valuable initial assessment tool in detecting MSG tumors. It is inexpensive, accessible, harmless, and fast; however, MRI is the modality of choice due to its high sensitivity and specificity.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 25577417Liu/201519 articles/784 patients/792 SGTsMeta-Analysis
Key resultsThe diagnostic specificity and sensitivity of ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) was calculated for the differentiation of benign and malignant SGTs: for US, pooled sensitivity 63% and pooled specificity 92%; for CR, pooled sensitivity 83% and pooled specificity 85%; and for MRI, pooled sensitivity 81% and pooled specificity 89%. Statistical differences in sensitivity between the US and CT modalities and between the US and MRI modalities were recorded. The pooled sensitivity of CT and MRI was higher than that of US for clinical diagnosis of SGTs. The study concluded that due to the high specificity but poor sensitivity of the US modality, MRI was the modality of choice in differentiating between benign and malignant SGT due to its highest sensitivity and specificity.
Evidence Search (Salivary gland ultrasound OR ultrasonography) AND (salivary gland tumors OR salivary gland disease) AND (MRI OR Magnetic resonance imaging)
Comments on
The Evidence
Validity of Liu et al.: A meta-analysis of 19 articles determined to be eligible from among 102 articles collected from 5 databases, including Embase, Pubmed, Springerlink, Sciencedirect, and Cochrane library databases, which were searched for publications from September 1982 to April 2013. The reliability for diagnosing MSG tumors using US, CT and MRI was performed for 784 patients and 792 SGTs in the chosen studies. The selected studies were required to have lesion origin, pathologic diagnosis, study type, and one of US, CT, or MRI results. The data was extracted by two authors independently and these items were deemed essential: description of population, such as age and gender ratios, publication year, study type, lesion number and location, study design, and imaging analysis related to the research. There were only 5 articles evaluating CT, 4 articles evaluating US and 12 articles evaluating MRI. The sample size for CT and US was too small for statistical analysis when the funnel plot was used to test diagnostic effect. Meta regression was used to analyze the relationship between the diagnostic odds ratio (DOR) and the composite variables; unfortunately, no significant relationship was found (P > .05).
Applicability Ultrasound is a great primary diagnostic tool for tumors in the salivary gland; however, having a high specificity but poor sensitivity doesn’t allow it to differentiate between benign and malignant tumors. MRI is the modality of choice for identifying the tumors behavior due to its high sensitivity and specificity. Some of the major features of the US modality include being inexpensive for patients and practitioners and being smaller in size, hence the possibility of being available in every practice, and fast and immediate diagnosis of potential tumor presence. MRI has a higher specificity and sensitivity in differentiating between malignant and benign SGTs, but due to its much more expensive cost for patients and practitioners, huge size requiring a large physical space, and longer processing and diagnosing time, it could not be the primary modality of choice for initial diagnosis and should be used for a more detailed diagnosis if US reveals any mass or if patients are experiencing signs of pain, swelling or xerostomia.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (Oral Surgery)
Keywords salivary gland tumors, MRI, ultrasound, computed tomography, diagnostic accuracy
ID# 3517
Date of submission: 12/04/2022spacer
E-mail morcos@livemail.uthscsa.edu
Author Dr. Mina Morcos
Co-author(s) Dr. Christine Melch
Co-author(s) e-mail melch@livemail.uthscsa.edu
Faculty mentor/Co-author Dr. Hassem Geha
Faculty mentor/Co-author e-mail geha@uthscsa.edu
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