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Accuracy of quantitative ultrasound elastography for differentiation of malignant and benign breast abnormalities: a meta-analysis

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Abstract

The purpose of this study was to systematically review recent literature on diagnostic performance of strain ratio and length ratio, two different strain measurements in ultrasound elastography, for differentiating benign and malignant breast masses. A literature search of PubMed and other medical and general purpose databases from inception through January 2012 was conducted. Published studies that evaluated the diagnostic performance of ultrasound elastography alone reporting either strain ratio or length ratio for characterization of focal breast lesions and using cytology (fine needle aspiration) or histology (core biopsy) as a reference standard were included. Summary diagnostic performance measures were assessed using bivariate generalized linear mixed modeling. Nine studies reported strain ratio for 2,087 breast masses (667 cancers, 1,420 benign lesions). Summary sensitivity and specificity were 88 % (95 % Credible Interval (CrI), 84–91 %), and 83 % (95 % CrI, 78–88 %), respectively. The positive and negative likelihood ratios (LR) were 5.57 (95 % CrI, 3.85–8.01) and 0.14 (95 % CrI, 0.09–0.20), respectively. The inconsistency index for heterogeneity was 6 % (95 % CrI, 1–22 %) for sensitivity and 8 % (95 % CrI, 3–24 %) for specificity. Analysis of three studies reporting length ratio for 450 breast masses demonstrated sensitivity and specificity of 98 % (95 % CrI, 93–99 %) and 72 % (95 % CrI, 31–96 %), respectively. Strain ratio and length ratio have good diagnostic performance for distinguishing benign from malignant breast masses. Although, this performance may not be incrementally superior to that of breast imaging reporting and data system (BIRADS) in B-mode ultrasound, the application of USE using strain ratio or length ratio in combination with USB may have the potential to benefit the patients, and this requires further comparative effectiveness and cost-effectiveness analyses.

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Abbreviations

USB:

B-mode ultrasound

USE:

Breast ultrasound elastography

BIRADS:

Breast imaging reporting and data system

CrI:

Credible interval

FN:

False negatives

FP:

False positives

I 2 :

Inconsistency index

LR:

Likelihood ratios

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-analyses

QUADAS:

Quality Assessment of Diagnostic Accuracy Studies

STARD:

Standards for Reporting of Diagnostic Accuracy checklist

SROC:

Summary receiver operating characteristic

TN:

True negatives

TP:

True positives

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Conflict of interest

Ruth Carlos is a member of physician’s advisory board of Philips. Gelareh Sadigh, Colleen Neal and Ben Dwamena have no conflict of interest to declare.

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Authors and Affiliations

  1. Department of Radiology, University of Michigan Medical Center, 1500 E. Medical Center Dr, B1 132H Taubman Center, Ann Arbor, MI, 48109-5302, USA

    Gelareh Sadigh

  2. Department of Radiology, Division of Magnetic Resonance Imaging, University of Michigan Medical Center, Ann Arbor, MI, USA

    Ruth C. Carlos

  3. VA Ann Arbor Healthcare System, Ann Arbor, MI, USA

    Ruth C. Carlos, Colleen H. Neal & Ben A. Dwamena

  4. Department of Radiology, Division of Breast Imaging, University of Michigan Medical Center, Ann Arbor, MI, USA

    Colleen H. Neal

  5. Department of Radiology, Division of Nuclear Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA

    Ben A. Dwamena

Authors
  1. Gelareh Sadigh
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  4. Ben A. Dwamena
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Correspondence to Gelareh Sadigh.

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Sadigh, G., Carlos, R.C., Neal, C.H. et al. Accuracy of quantitative ultrasound elastography for differentiation of malignant and benign breast abnormalities: a meta-analysis. Breast Cancer Res Treat 134, 923–931 (2012). https://doi.org/10.1007/s10549-012-2020-x

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