Breast Lesion Elastography Region of Interest Selection and Quantitative Heterogeneity: A Systematic Review and Meta-Analysis

Abstract Background: Breast cancer is one of the most common causes of death among women worldwide. Early detection and diagnosis will be helpful to reduce mortality and improve prognosis. It is urgent to develop efficient detection technology for breast cancer. Mammographic screening is a valuable tool for early detection of breast cancer. However, the increased density of breast tissue significantly reduces the diagnostic accuracy. Aim of Study: To provide an overview of the different reported elasticities of specific breast pathologies based on ultrasound elastography. Material and Methods: A total of 35 articles including 8316 patients and 9057 breast lesions were included in the pooled analysis of which 3060 malignant lesions were included from 40 studies. The median incidence of malignant breast lesion is 37.1% calculated from the incidence of malignant lesions of all included studies. Seven of the included studies assessed VTIQ. Mean age varied along all included studies. Results: The sensitivity and specificity of Emax, Emean and Eratio for the diagnosis of breast cancer varied according to the interpretative criteria used to define a test as positive. The summary estimates of sensitivity and specificity were 82.58% (95% CI 78.32% to 86.16%) and 84.12% (95% CI 79.07% to 87.07%) for Emean, 86.19% (95% CI 81.60% to 89.77%) and 88.56% (95% CI 88.56% to 91.54%) for Emax, and 87.50% (95% CI 77.47% to 93.44%) and 79.30% (95% CI 68.21% to 87.24%) for Eratio respectively. Regarding DOR, Emax achieved the highest value 48.32 (95% CI 28.7 to 67.8) which means there are 48 times the odds of obtaining an Emax positive result in a diseased rather than a non-diseased person. Meta-regression analysis was conducted to assess the impact of two covaries; Emean and Emax using Likelihood ratio test and revealed significant difference existed with higher summary sensitivity (x2=35.04, p < 001) and specificity (x2=18.65, p < 001) in Emax than Emean. SROC curves were used to show the distribution of sensitivity and specificity of Emax, Emean and Eratio in the Roc space as well as the prediction region. Conclusion: 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. SWE can provide additional information on predicting breast cancer prognosis. However, the possibility of false-positive and false-negative results should be considered during interpretation.