Breast Lesions: Quantitative Diagnosis Using Ultrasound Shear Wave Elastography—A Systematic Review and Meta-Analysis

Abstract

The aim of this meta-analysis was to estimate the diagnostic performance of shear wave elastography (SWE) in differentiating malignant from benign breast lesions. A literature search of PubMed, Web of Science and Scopus up to November 2014 was conducted. A summary receiver operating characteristic curve was constructed, and pooled weighted estimates of sensitivity and specificity were calculated using a bivariate mixed-effects regression model. Thirty-three studies, which included a total of 5838 lesions (2093 malignant, 3745 benign) from 5397 patients, were finally analyzed. Summary sensitivity and specificity were 0.886 (95% confidence interval [CI], 0.858–0.909) and 0.866 (95% CI, 0.833–0.894), respectively. The pooled diagnostic odds ratio was 50.410 (95% CI, 34.972–72.664). And the area under the receiver operating characteristic curve of SWE was 0.94 (95% CI, 0.91–0.96). No publication bias existed among these studies (p = 0.245). In the subgroup analysis, sensitivity and specificity were 0.862 (95% CI, 0.811–0.901) and 0.875 (95% CI, 0.793–0.928) among 1552 lesions from 1429 patients in the 12 studies using acoustic radiation force impulse imaging and 0.897 (95% CI, 0.863–0.923) and 0.863 (95% CI, 0.831–0.889) among another 4436 lesions from 4097 patients in the 21 studies using supersonic shear imaging. When analysis confined to 9 studies evaluated the diagnostic performance of combination SWE and conventional ultrasound, the area under the curve was 0.96 (95% CI, 0.94–0.97), yielding a sensitivity of 0.971 (95% CI, 0.941–0.986) and specificity of 0.801 (95% CI, 0.733–0.856). SWE seems to be a good quantitative method for differentiating breast lesions, with promise for integration into routine imaging protocols.