The Role of Contrast-Enhanced Ultrasound in the Diagnosis and Pathologic Response Prediction in Breast Cancer: A Meta-analysis and Systematic Review

Shi-Chong Zhou; Jian Le; Jin Zhou; Yun-Xia Huang; Lang Qian; Cai Chang

doi:10.1016/j.clbc.2020.03.002

The Role of Contrast-Enhanced Ultrasound in the Diagnosis and Pathologic Response Prediction in Breast Cancer: A Meta-analysis and Systematic Review

Clin Breast Cancer. 2020 Aug;20(4):e490-e509. doi: 10.1016/j.clbc.2020.03.002. Epub 2020 Mar 20.

Authors

Shi-Chong Zhou¹, Jian Le¹, Jin Zhou¹, Yun-Xia Huang¹, Lang Qian¹, Cai Chang²

Affiliations

¹ Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
² Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China. Electronic address: changcai_fuscc@hotmail.com.

PMID: 32371140
DOI: 10.1016/j.clbc.2020.03.002

Abstract

Purpose: To determine the overall performance of contrast-enhanced ultrasound (CEUS) in differentiating between benign and malignant breast lesions and in predicting the pathologic response to neoadjuvant chemotherapy (NAC) in patients with breast cancer (BC).

Materials and methods: Articles published up to April 2019 were systematically searched in Medline, Web of Science, and China National Knowledge Infrastructure. The sensitivities and specificities across studies, the calculations of positive and negative likelihood ratios (LR⁺ and LR^-), diagnostic odds ratio (OR), and constructed summary receiver operating characteristic curves were determined. Methodologic quality was assessed using the QUADAS (Quality Assessment of Diagnostic Accuracy Studies) tool. Subgroup analyses and metaregression were performed on prespecified study-level characteristics.

Results: Fifty-one studies involving 4875 patients with 5246 breast lesions and 10 studies involving 462 patients with BC receiving NAC were included. Methodologic quality was relatively high, and no publication bias was detected. The overall sensitivity, specificity, diagnostic OR, LR⁺, and LR^- for CEUS were 0.88 (95% confidence interval [CI], 0.86-0.89), 0.82 (95% CI, 0.80-0.83), 30.55 (95% CI, 21.40-43.62), 4.29 (95% CI, 3.51-5.25), and 0.16 (95% CI, 0.13-0.21), respectively, showing statistical heterogeneity. Multivariable metaregression analysis showed contrast mode to be the most significant source of heterogeneity. The overall sensitivity, specificity, LR⁺, LR, and diagnostic OR of CEUS imaging in predicting the overall pathologic response to NAC in patients with BC were 0.89 (95% CI, 0.83-0.93), 0.83 (95% CI, 0.78-0.88), 4.49 (95% CI, 3.04-6.62), 0.16 (95% CI, 0.10-0.24,), and 32.21 (95% CI, 16.74-62.01), respectively, showing mild heterogeneity.

Conclusion: Our data confirmed the excellent performance of breast CEUS in differentiating between benign and malignant breast lesions as well as pathologic response prediction in patients with BC receiving NAC.

Keywords: Breast lesions; CEUS; Diagnosis; Meta-analysis; Pathologic response.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Antineoplastic Combined Chemotherapy Protocols / pharmacology*
Antineoplastic Combined Chemotherapy Protocols / therapeutic use
Breast / diagnostic imaging*
Breast / drug effects
Breast / pathology
Breast / surgery
Breast Neoplasms / diagnosis*
Breast Neoplasms / therapy
Contrast Media / administration & dosage
Diagnosis, Differential
Drug Resistance, Neoplasm
Female
Humans
Mastectomy
Neoadjuvant Therapy / statistics & numerical data*
Odds Ratio
Prognosis
ROC Curve
Ultrasonography, Mammary / methods*

Substances

Contrast Media