Benefits of Conventional Ultrasound Combined With Elastography or Contrast-Enhanced Ultrasound for Breast Non-mass...

This systematic review and meta-analysis analyzed the effectiveness of combining conventional ultrasound (US) with ultrasound elastography (UE) or contrast-enhanced ultrasound (CEUS) for diagnosing breast non-mass lesions (NMLs).

PubMed, Cochrane Library, Web of Science and Embase databases were searched up to Oct. 2023. Pooled sensitivity and specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), post-test probability and the area under the summary receiver operating characteristic (SROC) curve were used to evaluate diagnostic efficacy.

A total of 1040 NMLs (533 malignant NMLs) from 14 studies were included. The pooled sensitivity, specificity, PLR, NLR and DOR of conventional US were 93% (95% confidence intervals [95% CI]: 82-98), 52% (95% CI: 33-70), 1.9 (95% CI: 1.4-2.8), 0.13 (95% CI: 0.06-0.29) and 15 (95% CI: 7-33). For the studies combined US with UE, the pooled sensitivity, specificity, PLR, NLR and DOR were 93% (95% CI: 87-96), 71% (95% CI: 54-84), 3.2 (95% CI: 2.0-55.4), 0.10 (95% CI: 0.06-0.17) and 33 (95% CI: 19-56). For the studies combined US with CEUS, the pooled sensitivity, specificity, PLR, NLR and DOR were 91% (95% CI: 85-95), 79% (95% CI: 71-85), 4.3 (95% CI: 3.1-6.0), 0.11 (95% CI: 0.06-0.20) and 40 (95% CI: 18-87). The area under the SROC curve was 84% (95% CI: 80-87), 93% (95% CI: 90-95) and 91% (95% CI: 88-93), respectively. We found no evidence of publication bias.

The addition of UE or CEUS to conventional US can improve the specificity and has satisfactory diagnostic performance for diagnosing breast NMLs. Threshold of Breast Imaging Reporting and Data System categories, dose of contrast agent and study design are factors contributing to heterogeneity.