Value of Contrast-Enhanced Ultrasound in Differential Diagnosis of Preoperative Benign and Malignant Breast Mass: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 ZHANGXiao-guang ¹ , ZHANGXiao-li ² , Palida·Paerhati ¹ , ZHANGYu ³ ,  Nadire·Tieliewuhan ¹

1. Ultrasound Diagnosis Medicine Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, China;
2. Department of Orthopedics, People's Hospital of Zhecheng County, Henan Province, Shangqiu 476200, China;
3. Physical Check-ups and Health Management Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, China;

Corresponding author：

Nadire·Tieliewuhan, Email: nadire607@163.com

Keywords：

Breast mass; Contrast-enhanced ultrasonography; Differential diagnosis; Systematically review; Diagnostic test

DOI：

10.7507/1672-2531.20140014

Video：

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Objective To systematically review the clinical value of the contrast-enhanced ultrasonic in the diagnosis of breast tumors. Methods We electronically and comprehensively searched the databases including The Cochrane Library (Issue 2, 2013), PubMed, CNKI, WanFang Data, Chaoxing medalink, VIP, and CBM for clinical research reports of diagnosing breast cancer with Contrast-enhance ultrasonic (all from foundation to May 2013). Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies according to the QUADAS items. The Meta-DiSc software (version 1.4) was used to conduct pooling on sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio. Heterogeneity test was performed and the summary receiver operating characteristic (SROC) curve was drawn for area under the curve (AUC). Results A total of 19 studies involving 1 161 participants were included. The results of meta-analysis showed that, specificity, the pooled sensitivity, positive likelihood ratio, negative likelihood ratio and DOR were 0.79 (95%CI 0.75 to 0.82), 0.86 (95%CI 0.83 to 0.89), 3.92 (95%CI 2.77 to 6.56), 0.18 (95%CI 0.13 to 0.26), and 25.86 (95%CI 13.77 to 48.55), respectively. The AUC of the SROC curve was 0.917 0. Conclusion The current evidence shows that contrast-enhanced ultrasonic has high sensitivity and specificity in the diagnosis of preoperative benign and malignant breast mass, which indicates that it could be used as a good method to diagnosing breast tumors.

Citation： ZHANGXiao-guang, ZHANGXiao-li, Palida·Paerhati, ZHANGYu, Nadire·Tieliewuhan. Value of Contrast-Enhanced Ultrasound in Differential Diagnosis of Preoperative Benign and Malignant Breast Mass: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2014, 14(1): 79-84. doi: 10.7507/1672-2531.20140014 Copy

1.	Ricci P, Cantisani V, Ballesio L, et al. Benign and malignant breast lesions:efficacy of real time contrast enhanced ultrasound VS. magnetic resonance imaging. Ultras hall Med, 2007, 28(1):57-62.
2.	Yon HA, Westendorff J, Gregor M. Contrastenhanced ultrasound with sonovue:differentiation between benign and malignant focal liver lesions in 317 patients. Clin Ultrasound, 2010, 38(1):1-9.
3.	王小燕, 康利克, 蓝春勇, 等.乳腺恶性肿块超声造影特征表现及诊断.中国超声医学杂志, 2012, 28(8):705-708.
4.	刁骧, 艾昌林, 秦莉, 等译. QUADAS的制定:用于系统评价诊断性研究质量的工具.中国循证医学杂志, 2007, 7(4):296-306.
5.	张晓光, 帕丽达·帕尔哈提, 张雨, 等.彩色多普勒超声对女性乳腺癌诊断价值的Meta分析.中国循证医学杂志, 2013, 13(9):1073-1079.
6.	张天嵩, 钟文昭. Meta-DiSc软件在诊断试验Meta分析中的应用.循证医学, 2008, 8(2):97-100.
7.	Kedar RP, Cosgrove D, mc Cready VP, et al. Microbubble contrast agent for color Doppler US:effect on breast masses Work in progress. Radiology, 1996, 198(3):679-686.
8.	Huber S, Helbich T, Kettenbach J, et al. Effects of a micro bubble contrast agent on breast tumors:computer-assisted quantitative assessment with color Doppler US-early experience. Radiology, 1998, 208(2):485-489.
9.	Stuhrmann M, Aronius R, Schietzel M. Tumor vascularity of breast lesions:potentials and limits of contrast enhanced Doppler sonography. AJR Am J Roentgenol, 2000, 175(6):1585-1589.
10.	Moon WK, Im JG, Noh DY, et al. Nopalpable breast lesions:evaluation with power Doppler US and a microbubble contrast agent-initial experience. Radiology, 2000, 217(1):240-246.
11.	Yang WT, Metreweli C, Lam PK, et al. Benign and malignant breast masses and axillary nodes:evaluation with echo-enhanced color power Doppler US. Radiology, 2001, 220(3):795-802.
12.	Kook SH, Kwag HJ. Value of contrast-enhanced power Doppler sonography using a microbubble echo-enhancing gent in evaluation of small breast lesions. Clin Ultrasound, 2003, 31(5):227-238.
13.	Forsberg F, Goldberg BB, Merritt CR, et al. Diagnosing breast lesions with contrast-enhanced 3-dimensional power Doppler imaging. Ultrasound Med, 2004, 23(2):173-182.
14.	Zdemir A, Kilic K, Ozdemir H, et al. Contrast-enhanced power Doppler sonography in breast lesions:effect on differential diagnosis after mammography and gray scale sonography. Ultrasound Med, 2004, 23(2):183-195.
15.	Kettenbach J, Elbich T H, Huber S, et al. Computer-assisted quantitative assessment of power Doppler US:effects of micro bubble contrast agent in the differentiation of breast tumors. Eur J Radiol, 2005, 53(2):238-244.
16.	Jung EM, Jungius KP, Rupp N, et al. Contrast enhanced Harmon cult resound for differentiating breast tumors-first results. Cli Clin Hemorheol Microcirc, 2005, 33(2):109-120.
17.	Liu H, Jang YX, Liu JB, et al. Evaluation of breast lesions with contrast-enhanced ultrasound using the micro vascular imaging technique:initial observations. Breast, 2008, 17(5):532-539.
18.	Du J, Li FH, Fang H, et al. Micro vascular architecture of breast lesions:evaluation with cont rats-enhanced ultrasonographic micro flow imaging. Ultrasound Med, 2008, 27(6):833-842.
19.	赵红佳, 董宝玮, 许荣, 等.超声造影定量分析在乳腺肿瘤诊断中的应用价值.中华乳腺病杂志(电子版), 2008, 2(6):634-640.
20.	尤厚成, 刘健, 尤楠, 等.超声造影对乳腺良恶性肿块鉴别诊断的价值.中国普外基础与临床杂志, 2011, 18(8):861-865.
21.	迪丽努尔·买买提明, 尹科, 等.实时超声造影对乳腺良、恶性肿瘤的鉴别诊断价值.新疆医科大学学报, 2011, 34(8):847-849, 854.
22.	陈俊, 丁炎, 周锋盛, 等.乳腺癌超声造影与MRI诊断价值比较分析.海南医学, 2011, 22(21):100-102.
23.	邵小慧, 董晓秋, 王思明, 等.彩色多普勒超声与实时灰阶超声造影对乳腺肿瘤的诊断价值比较.实用肿瘤学杂志, 2012, 26(3):232-235.
24.	陈杰, 吴晓萍, 李旭霞, 等.超声造影和彩色多普勒超声联合检查乳腺肿块的临床价值.医学影像学杂志, 2012, 22(2):286-287.
25.	Broumas AR, Pollard RE, Bloch SH, et al. Contrast-enhanced computed tomography and ultrasound for the evaluation of tumor blood flow. Invest Radiol, 2005, 40(3):134-147.
26.	Houssami N, Cuzick J, Dixon JM. The prevention, detection, and management of breast cancer. Med J Aust, 2006, 184(5):230-234.
27.	Taylor D, Lazberger J, Ives A, et al. Reducing delay in the diagnosis of pregnancy-associated breast cancer:how imaging can help us. Med Imaging Radiat Oncol, 2011, 55(1):33-42.

1. Ricci P, Cantisani V, Ballesio L, et al. Benign and malignant breast lesions:efficacy of real time contrast enhanced ultrasound VS. magnetic resonance imaging. Ultras hall Med, 2007, 28(1):57-62.
2. Yon HA, Westendorff J, Gregor M. Contrastenhanced ultrasound with sonovue:differentiation between benign and malignant focal liver lesions in 317 patients. Clin Ultrasound, 2010, 38(1):1-9.
3. 王小燕, 康利克, 蓝春勇, 等.乳腺恶性肿块超声造影特征表现及诊断.中国超声医学杂志, 2012, 28(8):705-708.
4. 刁骧, 艾昌林, 秦莉, 等译. QUADAS的制定:用于系统评价诊断性研究质量的工具.中国循证医学杂志, 2007, 7(4):296-306.
5. 张晓光, 帕丽达·帕尔哈提, 张雨, 等.彩色多普勒超声对女性乳腺癌诊断价值的Meta分析.中国循证医学杂志, 2013, 13(9):1073-1079.
6. 张天嵩, 钟文昭. Meta-DiSc软件在诊断试验Meta分析中的应用.循证医学, 2008, 8(2):97-100.
7. Kedar RP, Cosgrove D, mc Cready VP, et al. Microbubble contrast agent for color Doppler US:effect on breast masses Work in progress. Radiology, 1996, 198(3):679-686.
8. Huber S, Helbich T, Kettenbach J, et al. Effects of a micro bubble contrast agent on breast tumors:computer-assisted quantitative assessment with color Doppler US-early experience. Radiology, 1998, 208(2):485-489.
9. Stuhrmann M, Aronius R, Schietzel M. Tumor vascularity of breast lesions:potentials and limits of contrast enhanced Doppler sonography. AJR Am J Roentgenol, 2000, 175(6):1585-1589.
10. Moon WK, Im JG, Noh DY, et al. Nopalpable breast lesions:evaluation with power Doppler US and a microbubble contrast agent-initial experience. Radiology, 2000, 217(1):240-246.
11. Yang WT, Metreweli C, Lam PK, et al. Benign and malignant breast masses and axillary nodes:evaluation with echo-enhanced color power Doppler US. Radiology, 2001, 220(3):795-802.
12. Kook SH, Kwag HJ. Value of contrast-enhanced power Doppler sonography using a microbubble echo-enhancing gent in evaluation of small breast lesions. Clin Ultrasound, 2003, 31(5):227-238.
13. Forsberg F, Goldberg BB, Merritt CR, et al. Diagnosing breast lesions with contrast-enhanced 3-dimensional power Doppler imaging. Ultrasound Med, 2004, 23(2):173-182.
14. Zdemir A, Kilic K, Ozdemir H, et al. Contrast-enhanced power Doppler sonography in breast lesions:effect on differential diagnosis after mammography and gray scale sonography. Ultrasound Med, 2004, 23(2):183-195.
15. Kettenbach J, Elbich T H, Huber S, et al. Computer-assisted quantitative assessment of power Doppler US:effects of micro bubble contrast agent in the differentiation of breast tumors. Eur J Radiol, 2005, 53(2):238-244.
16. Jung EM, Jungius KP, Rupp N, et al. Contrast enhanced Harmon cult resound for differentiating breast tumors-first results. Cli Clin Hemorheol Microcirc, 2005, 33(2):109-120.
17. Liu H, Jang YX, Liu JB, et al. Evaluation of breast lesions with contrast-enhanced ultrasound using the micro vascular imaging technique:initial observations. Breast, 2008, 17(5):532-539.
18. Du J, Li FH, Fang H, et al. Micro vascular architecture of breast lesions:evaluation with cont rats-enhanced ultrasonographic micro flow imaging. Ultrasound Med, 2008, 27(6):833-842.
19. 赵红佳, 董宝玮, 许荣, 等.超声造影定量分析在乳腺肿瘤诊断中的应用价值.中华乳腺病杂志(电子版), 2008, 2(6):634-640.
20. 尤厚成, 刘健, 尤楠, 等.超声造影对乳腺良恶性肿块鉴别诊断的价值.中国普外基础与临床杂志, 2011, 18(8):861-865.
21. 迪丽努尔·买买提明, 尹科, 等.实时超声造影对乳腺良、恶性肿瘤的鉴别诊断价值.新疆医科大学学报, 2011, 34(8):847-849, 854.
22. 陈俊, 丁炎, 周锋盛, 等.乳腺癌超声造影与MRI诊断价值比较分析.海南医学, 2011, 22(21):100-102.
23. 邵小慧, 董晓秋, 王思明, 等.彩色多普勒超声与实时灰阶超声造影对乳腺肿瘤的诊断价值比较.实用肿瘤学杂志, 2012, 26(3):232-235.
24. 陈杰, 吴晓萍, 李旭霞, 等.超声造影和彩色多普勒超声联合检查乳腺肿块的临床价值.医学影像学杂志, 2012, 22(2):286-287.
25. Broumas AR, Pollard RE, Bloch SH, et al. Contrast-enhanced computed tomography and ultrasound for the evaluation of tumor blood flow. Invest Radiol, 2005, 40(3):134-147.
26. Houssami N, Cuzick J, Dixon JM. The prevention, detection, and management of breast cancer. Med J Aust, 2006, 184(5):230-234.
27. Taylor D, Lazberger J, Ives A, et al. Reducing delay in the diagnosis of pregnancy-associated breast cancer:how imaging can help us. Med Imaging Radiat Oncol, 2011, 55(1):33-42.

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