title: Meta-analysis of contrast-enhanced ultrasound for the differentiation of benign and malignant breast lesions.
abstract: 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.
  
  
  OBJECTIVE
  To determine the overall performance of CEUS in the differentiation of benign and malignant breast lesions using meta-analysis.
  
  
  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.
  
  
  CONCLUSIONS
  CEUS has good sensitivity and specificity in the characterization of breast lesions and can potentially help to select suspicious breast mass for surgery.
authors.affiliation: Department of Diagnostic Ultrasound, The People's Hospital of Guangxi Zhuang Autonomous Region, PR China.
authors.forename: Qiao
authors.initials: Q
authors.lastname: Hu
authors.affiliation: Department of Diagnostic Ultrasound, The People's Hospital of Guangxi Zhuang Autonomous Region, PR China gxqyywxy@163.com.
authors.forename: Xiao Yan
authors.initials: XY
authors.lastname: Wang
authors.affiliation: Department of Diagnostic Ultrasound, First Affiliated Hospital of Guangxi Medical University, PR China.
authors.forename: Shang Yong
authors.initials: SY
authors.lastname: Zhu
authors.affiliation: Department of Diagnostic Ultrasound, The People's Hospital of Guangxi Zhuang Autonomous Region, PR China.
authors.forename: Li Ke
authors.initials: LK
authors.lastname: Kang
authors.affiliation: Department of Diagnostic Ultrasound, The People's Hospital of Guangxi Zhuang Autonomous Region, PR China.
authors.forename: Yan Ju
authors.initials: YJ
authors.lastname: Xiao
authors.affiliation: Department of Diagnostic Ultrasound, The People's Hospital of Guangxi Zhuang Autonomous Region, PR China.
authors.forename: Hong Yu
authors.initials: HY
authors.lastname: Zheng
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000145:classification / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008875:Middle Aged; D015588:Observer Variation; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D003287:Contrast Media
keywords: Contrast-enhanced ultrasound; breast cancer; diagnostic performance; heterogeneity; publication bias; subgroup analysis