| Background:Breast cancer has attracted wide attention worldwide due to its high morbidity and mortality,and most of the patients are treated with surgery-based comprehensive treatment.In recent years,neoadjuvant chemotherapy(NAC)has been widely used in clinical practice because of its many benefits.Monitoring the response to NAC can provide important prognostic information,so as to improve the survival of patients and improve the cancer management system.As the gold standard for evaluation,pathological evaluation methods can accurately evaluate the efficacy of NAC at the cellular level.However,the specimens must be extracted after NAC and the changes of lesions after NAC cannot be monitored in real time.Imaging methods can be used for noninvasive and timely evaluation.A variety of imaging techniques have important reference values in evaluating the response to neoadjuvant chemotherapy and guiding the choice of surgery.Among them,ultrasound has significant advantages in terms of availability,patient comfort and cost.However,conventional two-dimensional ultrasound is more subjective and less reliable in assessing the size of residual tumors after chemotherapy.Shear wave elastography(SWE),as a new low-cost ultrasound imaging technology developed in recent years,can measure tissue stiffness in a non-invasive and quantitative way.It has the potential ability to predict the response to NAC by assessing tissue stiffness.It shows better sensitivity,objectivity and repeatability in evaluating the response to neoadjuvant chemotherapy in breast cancer,and has high clinical application value.Purpose:SWE has been used to evaluate the response of breast cancer to NAC in clinical studies,but the existing results are still uncertain.In this paper,meta-analysis was used to systematically and comprehensively search the Chinese and English databases and analyze 16 relevant clinical studies published to explore the accuracy of shear wave elastography in evaluating the response to neoadjuvant chemotherapy in breast cancer,so as to guide further clinical decision-making more accurately and quickly.Methods:Using"Breast cancer","shear wave elastography","neoadjuvant chemotherapy","Breast Neoplasm","neoadjuvant therapy"and"Elasticity Imaging Techniques"as key search terms,Chinese and English databases such as CNKI,Wanfang,VIP,Sinomed,Pubmed,web of science,Embase,Cochrane Library were searched for all relevant articles included from the establishment of the database to January 2023.The Quality Assessment of Diagnostic Accuracy Studies-2(QUADAS-2)was used to evaluate the quality of the studies included in this Meta-analysis,and to extract the basic information of the eligible studies.The basic information table and four-grid table including true positive value(TP),true negative value(TN),false positive value(FP)and false negative value(FN)were made,and statistical analysis was performed according to the data.Secondly,Meta Disc1.4 software was used to detect the threshold effect and Stata16 software was used to detect the heterogeneity and draw the forest diagram.The results showed that there was significant heterogeneity.The random effect model was used to determine the evaluation value of shear wave elastography in the response to neoadjuvant chemotherapy for breast cancer according to the combined effect size such as sensitivity and specificity.Due to the significant heterogeneity among the studies,subgroup analysis and sensitivity analysis were performed to explore the possible factors causing the heterogeneity,and further explore the factors affecting the diagnostic performance according to the results.Deek’s funnel plot and Fagan plot were used to detect publication bias and post-test probability,respectively.Results:A total of 16 articles in Chinese and English that met the criteria were included in this Meta-analysis.The spearman correlation coefficient between the logarithm of sensitivity and the logarithm of(1-specificity)was 0.113,P=0.676,indicating that there was no threshold effect.The heterogeneity test I~2 was 71%(95%CI35%-100%),indicating that there was significant heterogeneity in this study.The pooled sensitivity and specificity were 0.81(95%CI 0.76-0.84)and 0.83(95%CI0.78-0.88),respectively.The pooled positive likelihood ratio and negative likelihood ratio were 4.85(95%CI 3.59-6.55)and0.23(95%CI 0.19-0.29),respectively.The diagnostic odds ratio(DOR)was 20.98(95%CI 13.52-32.55),and the area under the SROC curve was 0.86(95%CI 0.82-0.88).Conclusion:SWE has good diagnostic performance and is a non-invasive and useful imaging method for evaluating the response of breast cancer patients to NAC,which has high clinical value.As a quantitative elastic index of SWE,stiffness change is more accurate than velocity change in evaluating the response of NAC.3D SWE shows good diagnostic performance in evaluating the response of NAC,which provides a new option for clinical application. |
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