CEUS For Evaluating The Effects Of Neoadjuvant Chemotherapy In Breast Cancer:a Meta-analysis

Background:Breast cancer is a major problem for women’s health worldwide.Neoadjuvant chemotherapy has been applied to breast cancer,which not only improves the survival rate,but also guides surgery and lymph node dissection.There is no standard method for evaluating the effects.Pathology is based on tumor cells to accurately evaluate the effects,but it is invasive and delayed.Imaging methods such as mammography,computed tomography and magnetic resonance imaging have advantages and disadvantages in evaluating the effects of neoadjuvant chemotherapy.It is worth noting that ultrasonography has become the first choice for breast cancer because of its affordable,but conventional ultrasound is insensitive to blood flow.Contrast enhanced ultrasound can qualitatively and quantitatively reflect the tumor size and blood flow in order to increase the accuracy of evaluating the effects of neoadjuvant chemotherapy.Purpose:By using the Meta-analysis,all the relevant studies in Chinese and English database were included and analyzed,in order to evaluate the accuracy of contrast enhanced ultrasound in judging the effects of neoadjuvant chemotherapy in breast cancer.Methods:Systematic searches of the Cochrane Library、Embase、Pub Med、Web of Science、CNKI and Wan Fang libraries were performed to identify relevant studies.The search was updated on Jan 1,2022,without a beginning date limit.Studies were screened according to the established criteria.Quality Assessment of Diagnostic Accuracy Studies-2 has been used to assess the quality of studies with Rev Man5.4.The data were extracted from each study.The heterogeneity and threshold effect was explored with Stata16.0 and Meta-Disc1.4.We calculated the pooled effect index,95%confidence intervals,summary receiver operating characteristic curve and the area under the curve in order to measure the diagnostic performance of contrast enhanced ultrasound.Deek’s funnel plot was used to detect publication bias.If there was heterogeneity,which was defined as I~2≥50%,we conducted a subgroup and sensitivity analysis to explore the reason of heterogeneity.Result:Ultimately,18 articles of acceptable methodological quality were included in this meta-analysis.There was medium heterogeneity,which I~2 was 56%.But the research has no threshold effect,which P was 0.961.The pooled sensitivity was 0.86（0.83-0.89）,the pooled specificity was 0.82（0.75-0.87）,the pooled positive likelihood ratio was 4.7（3.5-6.5）,the pooled negative likelihood ratio was 0.17（0.13-0.21）,the pooled diagnostic odds ratio was 29（17-47）.The area under the curve was 0.89（0.86-0.91）.Deek’s funnel plot indicated that there was no significant publication bias.Subgroup analysis indicated that timing of evaluation may be a source of heterogeneity.Sensitivity analysis showed that the results were reasonable and stable.Conclusion:Contrast enhanced ultrasound has a high diagnostic performance for evaluating the effects of neoadjuvant chemotherapy in breast cancer because of high sensitivity and specificity.It has good clinical application value.