We conducted a systematic literature review using MEDLINE and Embase to identify articles on diagnostic accuracy of frozen section (FS) for salivary gland lesions published between January 1, 1985, and December 31, 2010. We also reviewed the reference lists of all identified articles and conducted a forward search using Scopus to identify all articles citing the reference set. Meta-analysis was used to produce a summary receiver operating characteristic (SROC) curve from which summary estimates of sensitivity and specificity were obtained. Study quality was assessed using the Quality of Diagnostic Accuracy Study (QUADAS) survey. The accuracy of FS was compared with that of fine-needle aspiration cytology using results from an earlier review. A set of 13 studies (1,880 cases) with extractable data met our inclusion criteria. The summary estimates for the area under the SROC curve, FS sensitivity, and FS specificity are 0.99 (95% confidence interval [CI], 0.98-1.00), 0.90 (95% CI, 0.81-0.94), and 0.99 (95% CI, 0.98-1.00), respectively. FS has acceptable accuracy (90% sensitivity, 99% specificity) and is consistently accurate across study centers.