The diagnostic value of contrast-enhanced ultrasound and superb microvascular imaging in differentiating benign from malignant solid breast lesions: A systematic review and meta-analysis

Abstract

OBJECTIVE: To investigate the added value of contrast-enhanced ultrasound (CEUS) and superb microvascular imaging (SMI) to the conventional ultrasound (US) in the diagnosis of breast lesions. METHODS: PubMed, EMBASE, Web of Science, Chinese national knowledge infrastructure databases, Chinese biomedical literature databases, and Wanfang were searched for relevant studies from November 2015 to November 2021. The quality of the included studies was evaluated using the Quality Assessment of Diagnostic Studies (QUADAS) tool. Meta-Disc version 1.4 was used to calculate sensitivity (SEN), specificity (SPE), positive likelihood ratio (LR +), negative likelihood ratio (LR–), area under curve (AUC), and diagnostic odds ratio (DOR). Meta-regression analysis was performed using STATA 16.0 software to compare the diagnostic accuracy of the two techniques. RESULTS: In the five studies included, 530 patients were eligible for this meta-analysis. For SMI, the pooled SEN and SPE were 0.75 (95% confidence interval [CI]: 0.69–0.91) and 0.88 (95% CI: 0.83–0.91), respectively, LR + was 5.75 (95% CI: 4.26–7.78), LR– was 0.29 (95% CI: 0.23–0.36), DOR was 21.42 (95% CI, 13.61–33.73), and AUC was 0.8871. For CEUS, the pooled SEN and SPE were 0.87 (95% CI: 0.82–0.91) and 0.86 (95% CI: 0.82–0.89), respectively, LR + was 5.92 (95% CI: 4.21–8.33), LR– was 0.16 (95% CI: 0.11–0.25), DOR was 38.27 (95% CI: 18.73–78.17), and AUC was 0.9210. CONCLUSIONS: Adding CEUS and (or) SMI to conventional US could improve its diagnostic performance in differentiating benign from malignant solid breast lesions.

Superb microvascular imaging for evaluation of microvascularity in breast nodules compared with conventional Doppler imaging

“…The growth rate of tumors is slow during the slow growth stage, but in the rapid proliferation stage, tumors grow fast after rich microangiogenesis which promotes rapid growth of tumors ( 19 ). Therefore, the evaluation of microangiogenesis in breast lesions is important to differentiate malignant from benign lesions ( 20 ). The characteristics of neovascularization in malignant breast nodules usually include large quantity, thin wall, disorganized tortuosity, and formation of arteriovenous fistula ( 21 , 22 ).…”

Contrast-Enhanced Ultrasonography (CEUS) in Imaging of the Reproductive System in Dogs: A Literature Review

“…There are hundreds of studies, including papers, reviews, and meta-analyses dealing with the application of CEUS in the diagnosis of breast tumors in women, which is one of the most diffuse oncological pathologies worldwide [92][93][94][95][96][97][98][99][100].…”

“…Thus, CEUS proved to be ineffective in the differentiation of canine mammary tumors, although it was very useful in identifying neoplastic macro and micro vascularization [44]. Conversely, recent systematic reviews and meta-analysis in women showed that CEUS is a good tool for improving ultrasound in differentiating benign and malignant breast lesions [100,105], as well as predicting pathological response in patients with breast cancer and NAC [95].…”

Clinical application of intraoperative ultrasound superb microvascular imaging in brain tumors resections: contributing to the achievement of total tumoral resection

“…Superb microvascular imaging (SMI) uses an adaptive algorithm to analyze the characteristics of motion artifacts, eliminate clutter signals, and realize low-speed microvascular visualization at a higher frame rate, higher spatial resolution, and with fewer motion artifacts without injecting contrast enhancement media [ 20 ]. SMI can operate in color SMI (cSMI) and monochrome SMI (mSMI).…”