{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T21:23:42Z","timestamp":1789507422204,"version":"build-2803163510"},"reference-count":61,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T00:00:00Z","timestamp":1769731200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T00:00:00Z","timestamp":1769731200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate the diagnostic utility of asymmetrical tonsils in detecting tonsillar malignancy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources<\/jats:title>\n                    <jats:p>PubMed, Embase, Scopus, and Cochrane Library; from inception until December 17, 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Review Methods<\/jats:title>\n                    <jats:p>We included observational studies of adult\/pediatric patients undergoing excisional tonsillectomy or incisional tonsillar biopsy that reported at least one diagnostic accuracy outcome for tonsillar asymmetry in predicting malignancy. We pooled estimates using frequentist univariate random\u2010effects generalized linear mixed models, examined and adjusted for publication bias via visual inspection, Egger's test, and trim\u2010and\u2010fill, performed influence and cumulative meta\u2010analyses, and used a Bayesian bivariate model as a sensitivity analysis. Outcome measures included the following: sensitivity, specificity, positive\/negative likelihood ratio (LR+\/LR\u2212), and positive\/negative predictive value (NPV\/PPV) with 95% confidence interval (95% CI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty\u2010nine studies (5178 participants) from 422 records were included. The risk of bias was low\u2010moderate. The sensitivity and specificity of tonsillar asymmetry as a diagnostic marker for malignancy were 77.2% (95% CI: 68.6%\u201084.0%) and 96.4% (95% CI: 91.6%\u201098.6%), respectively. The LR\u2212 was 0.24 (0.17\u20100.34) and LR+ was 21.44 (8.05\u201057.0). The NPV and PPV were 99.8% (95% CI: 99.1%\u201099.9%) and 4.31% (95% CI: 1.83%\u20109.80%), without considering clinical risks. With concomitant high\u2010risk clinical features such as lymphadenopathy, the PPV (probability of malignancy given asymmetrical tonsils) was 38.5% (30.3%\u201047.4%). Without other high\u2010risk features, the PPV was 0.16% (0.15%\u20100.18%). The overall quality of evidence was high.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Tonsillar asymmetry has a high specificity and moderate sensitivity for tonsillar malignancy. Due to the low prevalence of malignancy, the probability of malignancy is less than 1% if no other suspicious clinical features are present.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ohn.70132","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T10:29:23Z","timestamp":1769768963000},"page":"643-654","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Tonsillar Asymmetry and Malignancy: A Meta\u2010analysis of Diagnostic Accuracy"],"prefix":"10.1002","volume":"174","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2311-7845","authenticated-orcid":false,"given":"Esther Yanxin","family":"Gao","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head &amp; Neck Surgery Singapore General Hospital  Singapore"},{"name":"Yong Loo Lin School of Medicine National University of Singapore  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4433-6695","authenticated-orcid":false,"given":"Alicia Su Yun","family":"See","sequence":"additional","affiliation":[{"name":"Yong Loo Lin School of Medicine National University of Singapore  Singapore"},{"name":"Department of Otolaryngology KK Women's and Children's Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9411-6164","authenticated-orcid":false,"given":"Benjamin Kye Jyn","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head &amp; 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