Medical Radiology and Radiation Safety. 2026. Vol. 71. № 2

DOI:10.33266/1024-6177-2026-71-2-115-121

Karthik Shunmugavelu¹, Evangeline Cynthia Dhinakaran²

Role of Ultrasound in Salivary Gland Tumors: a Systematic Review

¹ Medical College Hospital and Research Institute Tambaram Kanchipuram, Tamilnadu, India

² Sree Balaji Medical College and Hospital, Tamilnadu, India

Contact person: Karthik Shunmugavelu, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

ABSTRACT

Background: Salivary gland tumors (SGTs) are a heterogeneous group of lesions, from benign to extremely malignant neoplasms. Early and correct diagnosis is critical for proper clinical management. Ultrasound (US), being an inexpensive, non-invasive, and readily available imaging technique, has a pivotal role in the initial assessment of SGTs. The last few years have added power to the diagnostic armamentarium of US through elastography and radiomics. This systematic review critically examines existing evidence regarding the diagnostic utility and accuracy of ultrasound to differentiate benign from malignant SGTs.

Material and methods: The review adhered to PRISMA guidelines. Systematic searches of electronic databases – PubMed, Scopus, and Web of Science – were conducted for original research articles published 2012–2025. Included studies compared ultrasound approaches (grayscale US, elastography, and radiomics-based US) for the diagnosis of SGTs, with diagnostic performance reported. Non-original papers, case reports, and non-diagnostic outcome reports were excluded. Data were extracted regarding study design, sample characteristics, ultrasound techniques, and diagnostic accuracy.

Results: Five studies were found based on the inclusion criteria. Grayscale ultrasound yielded high specificity (up to 90 %) but low sensitivity (as low as 38.9 %) for detecting malignant lesions. Elastography, including shear wave elastography (SWE) and real-time elastography (RTE), improved diagnostic sensitivity and specificity (SWE: sensitivity 74 %, specificity 62 %). Radiomics-based ultrasound had the highest reported diagnostic accuracy (90 %), sensitivity (78 %), and specificity (92 %). Ultrasound-guided fine needle aspiration (US-FNA) cytology always possessed superior diagnostic sensitivity (up to 91 %) in all studies. US-FNA cytology was also helpful in distinguishing between SGTs and other inflammatory and autoimmune disorders such as Sjögren’s syndrome.

Discussion: Gray-scale conventional ultrasound still forms a cornerstone of the initial evaluation of salivary gland tumors, but its low sensitivity makes adjunctive techniques necessary. Elastography adds useful information on tissue stiffness and enhances differentiation between benign and malignant lesions. Radiomics and artificial intelligence-based models represent an exciting horizon for objective, automated diagnosis but need clinical validation. US-FNA cytology is still irreplaceable for diagnostic confirmation. Standardization of the imaging protocol and multicenter validation studies involving more patients are required to implement these advances in everyday practice.

Conclusion: Ultrasound, particularly when integrated with advanced techniques such as elastography and radiomics, significantly enhances the non-invasive diagnostic workup of salivary gland tumors. However, ultrasound-guided FNA cytology continues to be the diagnostic gold standard. Future research should focus on large-scale validation, integration of computational tools, and standardized imaging approaches to further improve diagnostic accuracy and patient outcomes.

Keywords: salivary gland tumors, ultrasound, elastography, radiomics, diagnostic accuracy, fine needle aspiration cytology

For citation: Karthik Shunmugavelu, Evangeline Cynthia Dhinakaran. Role of Ultrasound in Salivary Gland Tumors: a Systematic Review. Medical Radiology and Radiation Safety. 2026;71(2):115–121. DOI:10.33266/1024-6177-2026-71-2-115-121

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Conflict of interest. The authors declare no conflict of interest.

Financing. The study had no sponsorship.

Contribution. Article was prepared with equal participation of the authors.

Article received: 20.01.2026. Accepted for publication: 25.02.2026.