| Objective:1.To evaluate the diagnostic value of four diagnostic parameters(maximum,mean,minimum,standard deviation)in two-dimensional shear wave elastography(2D-SWE)using different measurement methods in the differential diagnosis of benign and malignant breast masses by using meta-analysis.2.The diagnostic network meta-analysis(ANOVA model)was used to find out the best parameter in the differential diagnosis of benign and malignant breast masses among the four Young’s modulus parameters of 2D-SWE and its ultrasound system Aixplorer,and the best parameter in the differential diagnosis of benign and malignant breast masses among the three different shear wave speed parameters of2D-SWE.Methods:1.English databases(Pub Med,Embase,Scopus,Web of Science)and Chinese databases(CNKI,VIP and Wanfang)were searched for articles on 2D-SWE in the differential diagnosis of benign and malignant breast masses published from the establishment of the database to December 2021.After duplicate checking and screening the literature according to the inclusion and exclusion criteria,the quality assessment(QUADAS-2 tool)was conducted and the relevant information was extracted.2.Pooled sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic odds ratio and 95% confidence interval were calculated by mixed bivariate model.The summary receiver operating characteristic(SROC)curve was drawn and the area under the curve was calculated.Subgroup analysis was used to explore the sources of heterogeneity among studies,sensitivity analysis was used for the stability of the test results,and Deeks’ funnel plot was used to explore the publication bias among studies.3.Absolute sensitivity,absolute specificity,diagnostic odds ratio,relative sensitivity,relative specificity,and diagnostic odds ratio were fitted by the two-stage hierarchical model of the two-way ANOVA model.The degree of convergence of the model was assessed using trajectory plots with R-hat values.Stata software was used to draw the network relationship evidence map of network Meta.Results:1.A total of 114 articles were included in this study.The summary sensitivity of the maximum,mean,minimum,and standard deviation for differential diagnosis of benign and malignant breast masses combined was 0.85(95%CI:0.83,0.87),0.82(95%CI:0.80,0.85),0.74(95%CI:0.65,0.82),and0.85(95%CI:0.81,0.88),respectively,and the summary specificity of combined 0.90(95%CI:0.88,0.91),0.87(95%CI:0.86,0.89),0.86(95%CI:0.82,0.89),and 0.87(95%CI:0.83,0.90),respectively,and the diagnostic odds ratios were 51(95%CI:40,65),32(95%CI: 25,40),17(95%CI:11,28),37(95%CI:25,55),combined summary positive likelihood ratios of 8.30(95%CI:7.10,9.70),6.40(95%CI:5.70,7.30),5.20(95%CI:4.10,6.70),6.40(95%CI:5.10,8.20),combined summary negative likelihood ratios of0.16(95%CI:0.14,0.19),0.20(95%CI:0.18,0.23),0.30(95%CI:0.22,0.41),0.17(95%CI:0.14,0.22),and combined area under the SROC curve of 0.94(95%CI:0.91,0.96),0.92(95%CI:0.89,0.94),0.89(95%CI:0.85,0.91),and 0.92(95%CI:0.90,0.94),respectively.There was great heterogeneity among the studies that evaluated the diagnostic value of the four diagnostic parameters.The results of subgroup analysis suggested that the use of Aixplorer ultrasound system and Acuson ultrasound system had a great impact on the heterogeneity of various diagnostic parameters.2.Among D-SWE and Aixplorer,Emax has the strongest ability in the differential diagnosis of benign and malignant breast masses.Compared with Emax,Esd and Emean had the same sensitivity and the highest sensitivity.The relative specificities of Esd,Emean and Emin were all very close to 1,suggesting that Emax,Esd,Emean and Emin had similar diagnostic specificities.3.Among 2D-SWE,SWSmean has the strongest ability to differentiate benign and malignant breast masses.Compared with SWSmax,SWSmax and SWSmean had similar sensitivity.The relative specificity of SWSmean and SWSmin was very close to 1,indicating that SWSmax,SWSmean and SWSmin had similar diagnostic specificity.Conclusion:1.Among the diagnostic parameters of different measurement methods of 2D-SWE,the maximum value,mean value and standard deviation value have high diagnostic value in differentiating benign and malignant breast masses.2.Among the four kinds of Young’s modulus parameters of 2D-SWE and its ultrasound system Aixplorer,Emax value has the strongest ability to differentiate benign and malignant breast masses,and is more suitable for the differential diagnosis of benign and malignant breast masses in clinical practice.3.Among the four shear wave speed parameters of 2D-SWE,SWSmean value has the strongest ability to differentiate benign and malignant breast masses,and is more recommended for the differential diagnosis of benign and malignant breast masses in clinical practice. |
PDF Full Text Request