Diagnostic significance of ultrasound elastography strain ratio for benign and malignant breast lesions: a meta-analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XU Feng ^1,2 , LIU Qian ² , XIN Jianyang ² , LIU Xiao ² , ZHENG Hui ² , ZHANG Aimei ² , WU Zhoushi ² ,  ZHANG Pengcheng ¹

1. Department of Thyroid and Breast, Xiangyang No.1 People’s Hospital Affiliated to Hubei University of Medicine, Xiangyang, Hubei 441000, P. R. China;
2. The Forth Clinical College, Hubei University of Medicine, Shiyan, Hubei 442000, P. R. China;

Corresponding author：

ZHANG Pengcheng, Email: jrk2017@163.com

Keywords：

breast nodule; ultrasound elastography; strain ratio; diagnosis; meta-analysis

DOI：

10.7507/1007-9424.201707086

Video：

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Objective To evaluate the significance of the ultrasound elastography (UE) strain ratio (SR) in the diagnosis of breast nodule by meta-analysis. Methods A computer-based online search was conducted in PubMed, The Cochrane Library (Issue 6, 2017), EMbase, CNKI, VIP, CBM, WanFang data databases, and so on (establishment time to June 2017), to collect the relevant diagnostic trials of the SR for breast nodules. Two reviewers independently screened literatures, extracted data, and evaluated the methodological quality of included studies. The meta-analysis was performed by using Stata 12.0 and Meta-Disc 1.4 software, and the combined indexes included sensitivity (Sen), specificity (Spe), positive likelihood ratio (LR+), negative likelihood ratio (LR–), and diagnostic odds ratio (DOR). Results A total of 26 studies were finally included. The results of meta-analysis showed that, the pooled Sen, Spe, LR+, LR–, and DOR was 0.88 (95% CI was 0.87 to 0.90), 0.85 (95% CI was 0.84 to 0.86), 6.66 (95% CI was 5.26 to 8.43), 0.14 (95% CI was 0.11 to 0.17), and 53.37 (95% CI was 34.96 to 81.49), respectively, P<0.000 1. Conclusion SR has high diagnostic accuracy in the differential diagnosis of benign and malignant breast nodules, it is worthy of widely utilized in the clinic.

Citation： XU Feng, LIU Qian, XIN Jianyang, LIU Xiao, ZHENG Hui, ZHANG Aimei, WU Zhoushi, ZHANG Pengcheng. Diagnostic significance of ultrasound elastography strain ratio for benign and malignant breast lesions: a meta-analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(12): 1503-1512. doi: 10.7507/1007-9424.201707086 Copy

1.	徐锋, 葛淑君, 陈郴, 等. 细针穿刺细胞学检查诊断乳腺肿块良恶性价值的 Meta 分析. 中国循证医学杂志, 2017, 17(6): 644-651.
2.	Bojić T, Djordjević N, Karanikolić A, et al. Assessment of axillary lymph nodes involvement in patients with breast cancer depending on the tumor size and its histological and nuclear grades. Vojnosanit Pregl, 2012, 69(5): 414-419.
3.	蔡熹, 丁炎, 刘波, 等. 常规超声联合超声造影及弹性成像对糖尿病性乳腺病诊断价值的探讨. 南京医科大学学报(自然科学版), 2016, 36(4): 491-494.
4.	陈茂山, 黄云辉, 邓萍, 等. 三维超声对乳腺癌诊断价值的 Meta 分析. 现代肿瘤医学, 2017, 25(10): 1619-1623.
5.	马媛媛, 牟洋, 杨晓婧, 等. 乳腺恶性肿块超声造影增强特征表现与组织病理对照分析. 中华实用诊断与治疗杂志, 2016, 30(3): 246-248.
6.	刘灿, 沈严严. 超声新技术评估乳腺结节的研究进展. 中国中西医结合影像学杂志, 2017, 15(2): 241-244.
7.	陈夏珊, 许萍, 王怡. 超声弹性成像及新技术对乳腺肿块的诊断价值. 中国医学计算机成像杂志, 2013, 19(3): 288-291.
8.	Ophir J, Céspedes I, Ponnekanti H, et al. Elastography: a quantitative method for imaging the elasticity of biological tissues. Ultrason Imaging, 1991, 13(2): 111-134.
9.	Chen L, He J, Liu G, et al. Diagnostic performances of shear-wave elastography for identification of malignant breast lesions: a meta-analysis. Jpn J Radiol, 2014, 32(10): 592-599.
10.	Kim YS, Park JG, Kim BS, et al. Diagnostic value of elastography using acoustic radiation force impulse imaging and strain ratio for breast tumors. J Breast Cancer, 2014, 17(1): 76-82.
11.	时利英, 邓辉胜. 超声弹性成像在恶性肿瘤早期诊断中的价值. 实用肿瘤杂志, 2012, 27(6): 674-677.
12.	曾宪涛, 庄丽萍, 杨宗国, 等. Meta 分析系列之七: 非随机实验性研究、诊断性试验及动物实验的质量评价工具. 中国循证心血管医学杂志, 2012, 4(6): 496-499.
13.	艾金伟, 李德胜, 刘羽, 等. 国内 HLA-B27 诊断强直性脊柱炎价值的 Meta 分析. 中国循证医学杂志, 2015, 15(9): 1059-1067.
14.	智慧. 弹性应变率比值法在乳腺实性肿物良恶性超声诊断中的价值初探. 中华医学会第十次全国超声医学学术会议, 山东济南, 2009.
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16.	赵亮, 柳莉莎, 李明慧. 超声弹性应变率比值在乳腺良恶性肿瘤鉴别诊断中的应用价值. 中国全科医学, 2012, 15(18): 2074-2076.
17.	黄健民, 华金才, 金巧芳. 超声弹性成像应变率比值对乳腺肿块良恶性病灶的临床诊断价值研究. 中国现代医学杂志, 2014, 24(10): 100-103.
18.	张智琳. 超声弹性成像应变率比值对乳腺肿块良恶性的鉴别诊断价值分析. 中国医学工程, 2015, 23(7): 189-190.
19.	吴韵秋, 金梅, 何丽兰, 等. 超声弹性成像应变率比值法鉴别良恶性乳腺肿瘤的价值. 影像诊断与介入放射学, 2015, 24(2): 134-137.
20.	彭瑞芳, 杨韵贤, 郑苑君. 超声弹性成像与 BI-RADS-US 分级在乳腺良恶性肿块中的诊断价值. 中国当代医药, 2016, 23(7): 124-126.
21.	于鹏丽, 张婕, 闻宝杰, 等. 超声弹性应变率比值对 BI-RADS4 级乳腺肿块良恶性诊断价值的分析. 肿瘤学杂志, 2016, 22(6): 439-442.
22.	隋燕妮, 雷冬梅, 王先银, 等. 超声弹性成像联合 BI-RADS 分级对乳腺肿块的定性诊断价值. 中国妇幼保健, 2016, 31(19): 4063-4065.
23.	胡晓丹, 肖蓉, 杨昭晖. 超声弹性成像应变率比值法与改良 5 分法在乳腺良恶性肿瘤中的诊断价值. 中国医学影像学杂志, 2016, 24(12): 900-902.
24.	李云凌, 邵丽梅, 赵月环, 等. 乳腺占位病变准静态超声弹性成像诊断方法的对比研究. 医学影像学杂志, 2016, 26(12): 2236-2239.
25.	彭晓静, 李奥, 叶新华, 等. 应变式弹性成像与剪切波弹性成像技术鉴别诊断乳腺良恶性病灶的价值比较. 中华医学超声杂志(电子版), 2016, 13(12): 942-947.
26.	李明君, 肖萤. 超声 SR 比值测量及等级评分法对乳腺占位的诊断价值. 西南国防医药, 2017, 27(4): 354-357.
27.	江宁珠, 姜伟, 黄翠平, 等. 超声弹性成像联合超声造影诊断乳腺良恶性肿块的价值分析. 临床医学工程, 2017, 24(4): 447-448.
28.	韦羽娟, 骆峰, 吴敏萍. 超声弹性成像应变率比值法与评分法在不同年龄段女性乳腺癌诊断中的价值. 现代医药卫生, 2017, 33(11): 1688-1689.
29.	郑燕, 董凤林, 范晴敏. 超声弹性成像在 BI-RADS 4A 类乳腺肿块良恶性诊断中的应用. 中国超声医学杂志, 2017, 33(3): 206-208.
30.	欧阳春荣, 黄间娣, 钟倩萍, 等. 弹性应变率比值法、改良 5 分法联合超声 BI-RADS 分级对乳腺实性病变良恶性的诊断价值. 现代医用影像学, 2017, 26(2): 230-233.
31.	Zhi H, Xiao XY, Yang HY, et al. Ultrasonic elastography in breast cancer diagnosis: strain ratio vs 5-point scale. Acad Radiol, 2010, 17(10): 1227-1233.
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37.	Lee JH, Kim SH, Kang BJ, et al. Role and clinical usefulness of elastography in small breast masses. Acad Radiol, 2011, 18(1): 74-80.
38.	Alhabshi SM, Rahmat K, Abdul Halim N, et al. Semi-quantitative and qualitative assessment of breast ultrasound elastography in differentiating between malignant and benign lesions. Ultrasound Med Biol, 2013, 39(4): 568-578.
39.	Mu WJ, Zhong WJ, Yao JY, et al. Ultrasonic elastography research based on a multicenter study: adding strain ratio after 5-point scoring evaluation or not. PLoS One, 2016, 11(2): e0148330.
40.	Dong J, Ly A, Arpin R, et al. Breast fine needle aspiration continues to be relevant in a large academic medical center: experience from Massachusetts General Hospital. Breast Cancer Res Treat, 2016, 158(2): 297-305.
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1. 徐锋, 葛淑君, 陈郴, 等. 细针穿刺细胞学检查诊断乳腺肿块良恶性价值的 Meta 分析. 中国循证医学杂志, 2017, 17(6): 644-651.
2. Bojić T, Djordjević N, Karanikolić A, et al. Assessment of axillary lymph nodes involvement in patients with breast cancer depending on the tumor size and its histological and nuclear grades. Vojnosanit Pregl, 2012, 69(5): 414-419.
3. 蔡熹, 丁炎, 刘波, 等. 常规超声联合超声造影及弹性成像对糖尿病性乳腺病诊断价值的探讨. 南京医科大学学报(自然科学版), 2016, 36(4): 491-494.
4. 陈茂山, 黄云辉, 邓萍, 等. 三维超声对乳腺癌诊断价值的 Meta 分析. 现代肿瘤医学, 2017, 25(10): 1619-1623.
5. 马媛媛, 牟洋, 杨晓婧, 等. 乳腺恶性肿块超声造影增强特征表现与组织病理对照分析. 中华实用诊断与治疗杂志, 2016, 30(3): 246-248.
6. 刘灿, 沈严严. 超声新技术评估乳腺结节的研究进展. 中国中西医结合影像学杂志, 2017, 15(2): 241-244.
7. 陈夏珊, 许萍, 王怡. 超声弹性成像及新技术对乳腺肿块的诊断价值. 中国医学计算机成像杂志, 2013, 19(3): 288-291.
8. Ophir J, Céspedes I, Ponnekanti H, et al. Elastography: a quantitative method for imaging the elasticity of biological tissues. Ultrason Imaging, 1991, 13(2): 111-134.
9. Chen L, He J, Liu G, et al. Diagnostic performances of shear-wave elastography for identification of malignant breast lesions: a meta-analysis. Jpn J Radiol, 2014, 32(10): 592-599.
10. Kim YS, Park JG, Kim BS, et al. Diagnostic value of elastography using acoustic radiation force impulse imaging and strain ratio for breast tumors. J Breast Cancer, 2014, 17(1): 76-82.
11. 时利英, 邓辉胜. 超声弹性成像在恶性肿瘤早期诊断中的价值. 实用肿瘤杂志, 2012, 27(6): 674-677.
12. 曾宪涛, 庄丽萍, 杨宗国, 等. Meta 分析系列之七: 非随机实验性研究、诊断性试验及动物实验的质量评价工具. 中国循证心血管医学杂志, 2012, 4(6): 496-499.
13. 艾金伟, 李德胜, 刘羽, 等. 国内 HLA-B27 诊断强直性脊柱炎价值的 Meta 分析. 中国循证医学杂志, 2015, 15(9): 1059-1067.
14. 智慧. 弹性应变率比值法在乳腺实性肿物良恶性超声诊断中的价值初探. 中华医学会第十次全国超声医学学术会议, 山东济南, 2009.
15. 龚业琼, 申俊玲. 超声弹性成像比值法对乳腺良恶性肿块的诊断价值. 西部医学, 2012, 24(9): 1774-1776.
16. 赵亮, 柳莉莎, 李明慧. 超声弹性应变率比值在乳腺良恶性肿瘤鉴别诊断中的应用价值. 中国全科医学, 2012, 15(18): 2074-2076.
17. 黄健民, 华金才, 金巧芳. 超声弹性成像应变率比值对乳腺肿块良恶性病灶的临床诊断价值研究. 中国现代医学杂志, 2014, 24(10): 100-103.
18. 张智琳. 超声弹性成像应变率比值对乳腺肿块良恶性的鉴别诊断价值分析. 中国医学工程, 2015, 23(7): 189-190.
19. 吴韵秋, 金梅, 何丽兰, 等. 超声弹性成像应变率比值法鉴别良恶性乳腺肿瘤的价值. 影像诊断与介入放射学, 2015, 24(2): 134-137.
20. 彭瑞芳, 杨韵贤, 郑苑君. 超声弹性成像与 BI-RADS-US 分级在乳腺良恶性肿块中的诊断价值. 中国当代医药, 2016, 23(7): 124-126.
21. 于鹏丽, 张婕, 闻宝杰, 等. 超声弹性应变率比值对 BI-RADS4 级乳腺肿块良恶性诊断价值的分析. 肿瘤学杂志, 2016, 22(6): 439-442.
22. 隋燕妮, 雷冬梅, 王先银, 等. 超声弹性成像联合 BI-RADS 分级对乳腺肿块的定性诊断价值. 中国妇幼保健, 2016, 31(19): 4063-4065.
23. 胡晓丹, 肖蓉, 杨昭晖. 超声弹性成像应变率比值法与改良 5 分法在乳腺良恶性肿瘤中的诊断价值. 中国医学影像学杂志, 2016, 24(12): 900-902.
24. 李云凌, 邵丽梅, 赵月环, 等. 乳腺占位病变准静态超声弹性成像诊断方法的对比研究. 医学影像学杂志, 2016, 26(12): 2236-2239.
25. 彭晓静, 李奥, 叶新华, 等. 应变式弹性成像与剪切波弹性成像技术鉴别诊断乳腺良恶性病灶的价值比较. 中华医学超声杂志(电子版), 2016, 13(12): 942-947.
26. 李明君, 肖萤. 超声 SR 比值测量及等级评分法对乳腺占位的诊断价值. 西南国防医药, 2017, 27(4): 354-357.
27. 江宁珠, 姜伟, 黄翠平, 等. 超声弹性成像联合超声造影诊断乳腺良恶性肿块的价值分析. 临床医学工程, 2017, 24(4): 447-448.
28. 韦羽娟, 骆峰, 吴敏萍. 超声弹性成像应变率比值法与评分法在不同年龄段女性乳腺癌诊断中的价值. 现代医药卫生, 2017, 33(11): 1688-1689.
29. 郑燕, 董凤林, 范晴敏. 超声弹性成像在 BI-RADS 4A 类乳腺肿块良恶性诊断中的应用. 中国超声医学杂志, 2017, 33(3): 206-208.
30. 欧阳春荣, 黄间娣, 钟倩萍, 等. 弹性应变率比值法、改良 5 分法联合超声 BI-RADS 分级对乳腺实性病变良恶性的诊断价值. 现代医用影像学, 2017, 26(2): 230-233.
31. Zhi H, Xiao XY, Yang HY, et al. Ultrasonic elastography in breast cancer diagnosis: strain ratio vs 5-point scale. Acad Radiol, 2010, 17(10): 1227-1233.
32. Zhao QL, Ruan LT, Zhang H, et al. Diagnosis of solid breast lesions by elastography 5-point score and strain ratio method. Eur J Radiol, 2012, 81(11): 3245-3249.
33. Parajuly SS, Lan PY, Yun MB, et al. Diagnostic potential of strain ratio measurement and a 5 point scoring method for detection of breast cancer: Chinese experience. Asian Pac J Cancer Prev, 2012, 13(4): 1447-1452.
34. Liu XJ, Zhu Y, Liu PF, et al. Elastography for breast cancer diagnosis: a useful tool for small and BI-RADS 4 lesions. Asian Pac J Cancer Prev, 2014, 15(24): 10739-10743.
35. Thomas A, Degenhardt F, Farrokh A, et al. Significant differentiation of focal breast lesions: calculation of strain ratio in breast sonoelastography. Acad Radiol, 2010, 17(5): 558-563.
36. Kumm TR, Szabunio MM. Elastography for the characterization of breast lesions: initial clinical experience. Cancer Control, 2010, 17(3): 156-161.
37. Lee JH, Kim SH, Kang BJ, et al. Role and clinical usefulness of elastography in small breast masses. Acad Radiol, 2011, 18(1): 74-80.
38. Alhabshi SM, Rahmat K, Abdul Halim N, et al. Semi-quantitative and qualitative assessment of breast ultrasound elastography in differentiating between malignant and benign lesions. Ultrasound Med Biol, 2013, 39(4): 568-578.
39. Mu WJ, Zhong WJ, Yao JY, et al. Ultrasonic elastography research based on a multicenter study: adding strain ratio after 5-point scoring evaluation or not. PLoS One, 2016, 11(2): e0148330.
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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Diagnostic significance of ultrasound elastography strain ratio for benign and malignant breast lesions: a meta-analysis

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