Sensitivity analysis was performed by deleting one study each time to observe the changes of results. The analysis indicated that the results were stable. Moreover, no publication bias was found in the meta-analysis (VTTQ: P = .216; SWE: P = .08) (Fig. 5).
Among the included studies, the application value of SWE in discriminating malignant and benign breast lesions was controversial. In the study of Zhou et al, 193 women with 193 breast lesions were included to analyze the diagnostic performance of SWE, Emax, Emean, and Emin were adopted to represent tissue stiffness. However, the diagnostic sensitivity (0.52, 0.55 and 0.77) and specificity (0.86, 0.78, and 0.78) of these three parameters were all low compared with other studies. Meanwhile, Youk et al reported high detection sensitivity (0.92) and specificity (0.92) of SWE, in which Emax represent tissue elasticity. Evans et al (2012) found that the detection sensitivity of SWE was 0.97 (0.92–0.99), whereas specificity was only 0.69 (0.56–0.80). On the contrary, Evans et al (2010) reported 0.53 detection sensitivity and 0.83 detection specificity. The variances in results might be attributed to the differences in characters of patients, ethnicity or SWE parameters.
Subgroup analysis based on ethnicity, technology and SWE parameters was performed in our analysis. The diagnostic sensitivity, specificity and AUC of SWE in Caucasian population were all higher than in Asian population. As we all known, acoustic radiation force impulse (ARFI) includes VTTI and VTTQ. The result of VTTI is characterized by elastographic image, whereas the result of VTTQ is measured by SWV (m/s). Soft tissue shows slow SWV, compared with hard tissue. VTTQ has been used for diagnosis in thyroid, prostate, pancreas, liver, and breast.[42–46] In our study, subgroup analysis according to technology (VTTQ and SWE) was conducted. VTTQ showed higher detection specificity and accuracy than SWE. In terms of SWE parameters, the diagnostic performance of Emax was better than Emean.
The meta-analysis was based on 4128 patients and 4546 breast lesions. The results were reliable and stable. However, some defects must be pointed out. The number of articles based on Caucasian population was much less than that of Asian population. The accuracy of results on Caucasian population might be affected. In addition, significant heterogeneity exhibited between the included studies. The heterogeneity might be caused by the patients’ number, basic feature of patients, and experiments methods, and so on.
Our meta-analysis demonstrates that SWE is an accurate and reliable diagnostic tool in discriminating malignant and benign breast lesions. With wide application, SWE may significantly improve the early diagnostic of breast cancer.
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