Wubulihasimu M, Maimaitusun M, Xu X-L, Liu X-D, Luo B-M
Ultrasonic Medical Section of In-patient Department, The First People's Hospital of Kashigar Region, China.
Department of Ultrasound, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, China.
Clin Radiol. 2018 Nov;73(11):936-943. doi: 10.1016/j.crad.2018.06.004. Epub 2018 Jul 6.
To investigate the added value of contrast-enhanced ultrasound (CEUS) to the conventional ultrasound (US) in the diagnosis of breast lesions.
PubMed, EMBASE, and Web of Science were searched for relevant studies published between 24 May 2005, and 29 October 2017. Studies incorporating CEUS into the conventional US were included. The reference standard was set by means of histopathological findings. The quality assessment of diagnostic studies (QUADAS) instrument was used to assess the quality of the included studies. Meta-Disc version 1.4. was used to calculate the sensitivity, specificity, summary receiver-operating characteristic (sROC) curves, and area under the curve (AUC). Meta-regression with Stata 12.0 was used to compare the diagnostic accuracy of the two techniques.
Five studies, comprising 992 patients, were eligible for this meta-analysis. For conventional US, the pooled sensitivity and specificity for were 0.87 (95% confidence interval [CI]: 0.84-0.91) and 0.80 (95% CI: 0.76-0.84), respectively, the AUC was 0.9049. For CEUS-rerated US, the pooled sensitivity and specificity were 0.93 (95% CI: 0.90-0.95) and 0.87 (95% CI: 0.84-0.90). The AUC was 0.9482. Meta-regression showed the sensitivity of CEUS-rerated US did not differ from conventional US (p=0.29), while specificity showed significant difference (p<0.01). There was evidence of between-study heterogeneity regarding sensitivity and specificity for both assessments.
Adding CEUS to conventional US could improve the diagnostic performance in differentiating benign from malignant solid breast lesions, whilst retaining high sensitivity, especially in Breast Imaging-Reporting and Data System (BI-RADS) 3-5 lesions. A uniform standard to distinguish benign from malignant lesions might be needed for further clinical application.
探讨超声造影（CEUS）在乳腺病变诊断中相对于传统超声（US）的附加价值。
检索PubMed、EMBASE和Web of Science数据库，查找2005年5月24日至2017年10月29日期间发表的相关研究。纳入将CEUS纳入传统US的研究。参考标准通过组织病理学结果确定。采用诊断研究质量评估（QUADAS）工具评估纳入研究的质量。使用Meta-Disc 1.4版计算敏感性、特异性、汇总受试者操作特征（sROC）曲线和曲线下面积（AUC）。使用Stata 12.0进行Meta回归，比较两种技术的诊断准确性。
五项研究，共992例患者，符合本Meta分析的条件。对于传统US，合并敏感性和特异性分别为0.87（95%置信区间[CI]：0.84 - 0.91）和0.80（95% CI：0.76 - 0.84），AUC为0.9049。对于CEUS联合US，合并敏感性和特异性分别为0.93（95% CI：0.90 - 0.95）和0.87（95% CI：0.84 - 0.90）。AUC为0.9482。Meta回归显示，CEUS联合US的敏感性与传统US无差异（p = 0.29），而特异性有显著差异（p < 0.01）。两项评估的敏感性和特异性均存在研究间异质性证据。
在传统US基础上增加CEUS可提高鉴别乳腺实性良恶性病变的诊断性能，同时保持高敏感性，尤其是在乳腺影像报告和数据系统（BI-RADS）3 - 5类病变中。进一步临床应用可能需要统一的良恶性病变鉴别标准。
