Park Sun-Young, Kang Bong Joo
Devision of New Health Technology Assessment, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea.
Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Ultrasonography. 2021 Jul;40(3):318-332. doi: 10.14366/usg.20058. Epub 2020 Dec 24.
This study was undertaken to compare the diagnostic performance and biopsy reduction rate of combined shear-wave elastography (SWE) and B-mode ultrasonography (US) versus B-mode US alone for breast lesions and to determine the most discriminatory parameter in SWE.
A systematic review and meta-analysis were conducted. The resources for the study were obtained from MEDLINE, Embase, Cochrane Library, and KoreaMed on August 17, 2018. The quality of the articles was evaluated using the Scottish Intercollegiate Guidelines Network (SIGN) tool.
Twenty-five articles with 5,147 breast lesions were selected. The meta-analysis showed pooled sensitivities of 0.94 and 0.97 (P=0.087), pooled specificities of 0.85 and 0.61 (P=0.009), and area under the receiver operating characteristic curve (AUC) of 0.96 and 0.96 (P=0.095) for combined SWE and B-mode US versus B-mode US alone. When SWE was combined with B-mode US, the Breast Imaging Reporting and Data System category changed from 4 to 3 in 71.3% of the tests, decreasing the frequency of unnecessary biopsies by 41.1%. All four parameters of SWE (the color grade of lesion stiffness, maximum elasticity, mean elasticity, and color grade of lesion stiffness/homogeneity of the lesion) improved the specificity when they were added to B-mode US. The AUC for each SWE parameter was 0.99, 0.96, 0.96, and 0.93, respectively.
Adding SWE to B-mode US not only provides additional diagnostic information for differentiating between benign and malignant breast lesions, but also decreases the likelihood of unnecessary biopsies.
本研究旨在比较剪切波弹性成像（SWE）联合B型超声（US）与单纯B型超声对乳腺病变的诊断性能和活检减少率，并确定SWE中最具鉴别力的参数。
进行了系统评价和荟萃分析。研究资源于2018年8月17日从MEDLINE、Embase、Cochrane图书馆和KoreaMed获取。使用苏格兰校际指南网络（SIGN）工具评估文章质量。
选取了25篇包含5147个乳腺病变的文章。荟萃分析显示，SWE联合B型超声与单纯B型超声相比，合并敏感度分别为0.94和0.97（P = 0.087），合并特异度分别为0.85和0.61（P = 0.009），受试者操作特征曲线下面积（AUC）分别为0.96和0.96（P = 0.095）。当SWE与B型超声联合使用时，71.3%的检查中乳腺影像报告和数据系统类别从4级变为3级，不必要活检的频率降低了41.1%。SWE的所有四个参数（病变硬度的颜色分级、最大弹性、平均弹性以及病变硬度/病变均匀性的颜色分级）添加到B型超声中时均提高了特异度。每个SWE参数的AUC分别为0.99、0.96、0.96和0.93。
在B型超声中添加SWE不仅为鉴别乳腺良性和恶性病变提供了额外的诊断信息，还降低了不必要活检的可能性。
