Should we still consider lateral neck radiography in the evaluation of adenoid hypertrophy? A systematic review and meta-analysis.

BACKGROUND

Adenoid hypertrophy is a common childhood disorder that can lead to significant symptoms and complications. Early diagnosis and management are crucial for improving patient outcomes. While endoscopy is the gold standard for diagnosis, its invasiveness and cost are limiting factors. Lateral neck radiography may serve as an effective alternative for evaluating adenoid hypertrophy. This study aims to assess the role of X-rays in diagnosing and grading adenoid hypertrophy.

METHODS

From inception to October 2024, we conducted an extensive literature search across four databases on studies using X-rays to evaluate adenoidal hypertrophy, with endoscopy as a reference test. We calculated the sensitivity (SN) and specificity (SP) for each study and pooled the results in a random-effects meta-analysis model.

RESULTS

Our systematic review included 50 studies involving 12266 patients with adenoid hypertrophy. The pooled analysis revealed a SN of 0.751 and SP of 0.893 for lateral neck radiography in diagnosing mild adenoid hypertrophy. However, these values slightly decreased for moderate and severe adenoid hypertrophy, with a pooled SN of 0.618 and SP of 0.714 for moderate adenoid hypertrophy and a pooled SN of 0.637 and SP of 0.834 for severe adenoid hypertrophy.

CONCLUSION

Our study demonstrates moderate sensitivity and specificity of lateral neck radiography for diagnosing mild adenoid hypertrophy while also highlighting its diagnostic limitations for moderate and severe adenoid enlargement. Clinical evaluation and nasopharyngoscopy remain the optimal diagnostic modalities in evaluating adenoid hypertrophy.