Diagnostic accuracy of core needle biopsy versus fine-needle aspiration cytology in salivary gland malignancies: A systematic review and metaanalysis.

OBJECTIVES.: Accurate preoperative differentiation of salivary gland malignancies is critical for surgical planning. This study aimed to perform an updated systematic review and meta-analysis comparing the diagnostic accuracy of ultrasound-guided core needle biopsy (CNB) and fine-needle aspiration cytology (FNAC) in detecting salivary gland malignancies. METHODS.: A systematic search of electronic databases (MEDLINE, Embase, and the Cochrane Library) was conducted to update a foundational review. Studies comparing the diagnostic accuracy of CNB and FNAC for salivary gland tumors, with definitive surgical histopathology as the reference standard, were included. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-Comparative (QUADAS-C) tool. Pooled sensitivity, specificity, and diagnostic odds ratios (DOR) were estimated using random-effects models. A bivariate random-effects model was used to construct summary receiver operating characteristic (SROC) curves. RESULTS.: Ten studies comprising 3,902 procedures (2,064 FNAC and 1,838 CNB) were included. The pooled sensitivity of CNB (0.905 [95% CI, 0.874-0.936]; I2 = 0.0%) was higher than that of FNAC (0.601 [95% CI, 0.526-0.676]; I2 = 42.7%). Pooled specificity was comparably high for both modalities (CNB: 0.979 [95% CI, 0.958-1.000]; I2 = 82.9%; FNAC: 0.970 [95% CI, 0.954-0.985], I2 = 66.6%). The pooled DOR for CNB was higher than that for FNAC (492.468 vs. 42.624). The area under the SROC curve was also higher for CNB than for FNAC (0.903 vs. 0.865). The QUADAS-C assessment indicated predominantly low risk in the comparative index-test domain, with no high-risk judgements in any domain. CONCLUSION.: Ultrasound-guided CNB demonstrates higher pooled sensitivity than FNAC, while both modalities showed high pooled specificity. Given this higher sensitivity for detecting malignancies, CNB may be considered a preferred diagnostic option within a risk-adapted approach to salivary gland cancer management, especially when malignancy is clinically suspected.