Diagnostic accuracy of fine-needle aspiration cytology in salivary gland neoplasms: a systematic review and meta-analysis

INTRODUCTION: Fine-needle aspiration cytology is a widely used minimally invasive tool for salivary gland lesions, though diagnostic challenges arise due to overlapping features between benign and malignant tumors. This systematic review and meta-analysis evaluate its diagnostic performance in salivary gland neoplasms. METHODS: A comprehensive literature search was conducted in PubMed/MEDLINE, Embase, Scopus, and Web of Science. Studies reporting sensitivity, specificity, or sufficient data to construct 2 × 2 tables were included. Data extraction was performed independently by two reviewers, and study quality was assessed using the QUADAS-2 tool. Diagnostic accuracy was pooled using a bivariate random-effects model, and summary receiver operating characteristic curves were generated. Publication bias was evaluated using Deeks' funnel plot. RESULTS: A total of 56 studies were included, of which 32 were eligible for meta-analysis. The pooled sensitivity of FNAC was 0.79 (95% CI: 0.75-0.83), and specificity was 0.94 (95% CI: 0.93-0.96). The summary analysis demonstrated good discriminative ability with an area under the curve of 0.89. No significant publication bias was detected. CONCLUSIONS: FNAC demonstrates high diagnostic accuracy, with high specificity and moderate sensitivity, supporting its role as a reliable first-line diagnostic tool in salivary gland neoplasms.