Meta-analysis of contrast-enhanced ultrasound for the differentiation of benign and malignant breast lesions

BACKGROUND: Contrast-enhanced ultrasound (CEUS) is a non-invasive method for the assessment of breast lesions. The accuracy of CEUS in diagnosing of breast cancer has never been systematically assessed. PURPOSE: To determine the overall performance of CEUS in the differentiation of benign and malignant breast lesions using meta-analysis. MATERIAL AND METHODS: PubMed, Embase, Cochrane Library, and article references published before October 2012 were searched. Published studies that used histopathologic results as golden reference to assess the diagnostic performance of CEUS in patients suspected of having breast cancer and the data necessary to calculate the diagnostic results were included. The qualities of eligible studies for final meta-analysis were assessed by using the quality assessment of diagnostic studies (QUADAS) instrument. Sensitivity, specificity, summary receiver-operating characteristic (sROC) curves, and area under the curve were calculated to examine the diagnostic performance of CEUS. RESULTS: Of 16 eligible studies, 957 breast lesions were included in the original meta-analysis, among which heterogeneity arising from factors other than threshold effect was explored. Meta-regression analysis confirmed the contrast agent was the most significant factor cause of heterogeneity (P = 0.0012, relative diagnostic odds ratio [DOR] = 7.06). The use of perfluoro containing microbubbles (Sonovue or Optison) significantly increased the diagnostic precision compared with Levovist. The pooled weighted estimates of sensitivity and specificity for CEUS in the diagnosis of breast lesions were 0.86 (95% confidence interval [CI], 0.83, 0.89) and 0.79 (95% CI, 0.75, 0.83), respectively. CONCLUSION: CEUS has good sensitivity and specificity in the characterization of breast lesions and can potentially help to select suspicious breast mass for surgery.