Fu Jun, Li Yanyan, Li Na, Li Zhanzhan
Department of Oncology,
Department of Nursing, Xiangya Hospital, Central South University, Changsha, Hunan Province 410008, China.
Cancer Manag Res. 2018 Sep 6;10:3295-3303. doi: 10.2147/CMAR.S176494. eCollection 2018.
Three-dimensional (3-D) ultrasound is commonly used for screening breast cancer; however, the diagnostic accuracy of this method is unknown. Here, we performed a systematic search on the literature to assess the clinical utility of 3-D ultrasound in benign and malignant breast masses.
We conducted searches in several online databases covering all publications prior to August 15, 2017. The bivariate random effects model was used to assess the overall sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and summary area under receiver operating curve (AUC) with their corresponding 95% CI.
The overall sensitivity of 3-D ultrasound for diagnosing benign and malignant breast masses was 89% (95% CI, 83%-93%) and the specificity was 88% (95% CI, 83%-92%) with high heterogeneity (=81.9; 95% CI, 74.4-89.3, <0.001). Other parameters used to assess efficacy included PLR (5.57; 95% CI, 3.73-8.31), NLR (0.18; 95% CI, 0.11-0.28), and DOR (31.33; 95% CI, 15.19-64.61). The use of a Fagan diagram with a pretest probability of 20% yields a post-test probability of 65% with a PLR of 7. True post-test probability was calculated at 3%, with an NLR of 0.13. The summary receiver operating characteristic curve was 0.94 (95% CI, 0.92-0.96), with no evidence of publication bias.
Three-dimensional ultrasound offers high sensitivity and specificity, with a high AUC, indicating a strong diagnostic value for detecting benign and malignant breast masses. Three-dimensional ultrasound may therefore represent an excellent option for secondary analysis of unclear breast lesions.
三维（3-D）超声常用于乳腺癌筛查；然而，该方法的诊断准确性尚不清楚。在此，我们对文献进行了系统检索，以评估三维超声在乳腺良恶性肿块中的临床应用价值。
我们在多个在线数据库中进行检索，涵盖2017年8月15日前的所有出版物。采用双变量随机效应模型评估总体敏感性、特异性、阳性似然比（PLR）、阴性似然比（NLR）、诊断比值比（DOR）以及受试者操作特征曲线下的总结面积（AUC）及其相应的95%置信区间。
三维超声诊断乳腺良恶性肿块的总体敏感性为89%（95%置信区间，83%-93%），特异性为88%（95%置信区间，83%-92%），异质性较高（I² = 81.9；95%置信区间，74.4 - 89.3，P < 0.001）。用于评估疗效的其他参数包括PLR（5.57；95%置信区间，3.73 - 8.31）、NLR（0.18；95%置信区间，0.11 - 0.28）和DOR（31.33；95%置信区间，15.19 - 64.61）。使用预测试概率为20%的Fagan图，当PLR为7时，测试后概率为65%。实际测试后概率计算为3%，NLR为0.13。总结受试者操作特征曲线为0.94（95%置信区间，0.92 - 0.96），无发表偏倚证据。
三维超声具有高敏感性和特异性，AUC较高，表明对检测乳腺良恶性肿块具有较强的诊断价值。因此，三维超声可能是对不明乳腺病变进行二次分析的极佳选择。
