Diagnostic accuracy of Fine-Needle Aspiration (FNA) in comparison to Core Needle Biposy (CNB) in salivary gland lesion: A systemic review and meta-analysis

Background: Salivary gland tumors comprise 6% of total head and neck tumors. Parotid, being the major gland involved forms 80% of the cases while submandibular gland tumors make up 10-15% of the cases. However, the histopathology and cytology of these tumors are complex due to diverse patterns of growth and morphology exhibited by tumor cells, making the diagnosis a challenge. Despite being widely used as a preoperative diagnostic tool, fine needle aspiration yields results that are less than satisfactory, are timeconsuming, and require local anesthesia. Most inaccurate results are due to insufficient samples. To overcome this, core needle biopsy using (Ultrasound) US guidance is used. It helps in obtaining a larger specimen, has higher sensitivity, and most importantly, can help assess the status of capsular invasion along with tumor grading. While choosing the right method of diagnosis is extremely crucial to the management of tumors, this study aims to ascertain the superior method to accelerate preoperative diagnosis and management. Method: Detailed search through the medical literature was done using PubMed, Google Scholar, and Cochrane Library databases for the collection of relevant data. It was extracted keeping into consideration the inclusion and exclusion criteria. A total of 16 RCTs with a total of 2068 patients were selected. Meta-analysis was done using the two writers who independently assessed the caliber of each included study. The Cochrane tool was also used for bias risk apprehension. The statistical software packages RevMan (Review Manager, version 5.3), SPSS (Statistical Package for the Social Sciences, version 20), and Excel in Stata 14 were used to perform the statistical analyses. Results: FNAC as a tool for preoperative diagnosis has a sensitivity of 93%, a specificity of 98.5%, and a positive predictive value of 0.972 in comparison to Core Needle Biposy (CNB) in the diagnosis and intervention regarding Salivary gland tumors. Conclusion: The results suggest Core Needle Biposy (CNB) as a superior modality in the preoperative diagnosis of salivary gland tumors as compared to FNAC. However, FNAC can be used as a preliminary step in the process of diagnosis. Nevertheless, CNB overcomes the shortcomings of FNAC, making it a better method.