Diagnostic value of an automated breast volume scanner compared with a hand-held ultrasound: a meta-analysis

Abstract

Background: The diagnostic performance of an automated breast volume scanner (ABVS) compared with that of a hand-held ultrasound (HHUS) for breast cancer remains unclear. We performed a meta-analysis to compare the diagnostic performances of the ABVS and HHUS for breast cancer.

Methods: We searched PubMed, EMBASE, Cochrane, and SinoMed databases to identify eligible studies up until November 14, 2018. Studies comparing ABVS and HHUS for differentiating benign and malignant breast tumors were included. A meta-analysis was performed to generate pooled diagnostic accuracy parameters [sensitivity, specificity, diagnostic odds ratio (DOR), area under the curve (AUC), and the Q* index] and detection rates for ABVS and HHUS.

Results: Nine studies involving 1,376 patients and 1,527 lesions were included in the meta-analysis for diagnostic accuracy. The pooled sensitivity was 0.93 [95% confidence interval (CI), 0.91-0.95] for ABVS and 0.90 (95% CI, 0.88-0.92) for HHUS, and the pooled specificity was 0.86 (95% CI, 0.83-0.88) for ABVS and 0.82 (95% CI, 0.79-0.84) for HHUS. The pooled DOR was 88.66 (95% CI, 51.44-152.78) for ABVS and 41.06 for HHUS (95% CI, 26.58-63.42). The AUC of the summary receiver operating characteristic (SROC) was 0.9496 for ABVS and 0.9143 for HHUS, and the Q* index was 0.8899 for ABVS and 0.8469 for HHUS. Meta-regression showed no significant difference between the diagnostic accuracy of ABVS and HHUS (P=0.0771). No publication bias was found. Thirteen published studies involving 1,047 pathologically confirmed malignant lesions were included to generate a pooled detection rate. The pooled detection rate was 1.00 (95% CI, 1.00-1.00) for both ABVS and HHUS, for which a publication bias was found.

Conclusions: ABVS can be used as an appropriate screening tool for breast cancer as well as HHUS in diagnostic accuracy and detection rate. Considering other advantages of ABVS including non-radioactivity, sensitivity to dense breast, three-dimensional reconstruction, time-saving and repeatability, it might be a promising screening tool for young or dense-breast women in the future.

Keywords: Automated breast volume scanner (ABVS); breast cancer; hand-held ultrasound (HHUS); meta-analysis.

Figure 1

Flow chart concerning selection of the included studies. ^a, eight studies were selected for both diagnostic accuracy and detection rate analysis.

Figure 2

Quality of studies included in diagnostic accuracy analysis. (A) Graph depicting the risk of bias and applicability concerns and (B) a summary of the risk of bias and applicability concerns.

Figure 3

The pooled sensitivity and specificity for ABVS and HHUS. The pooled sensitivity was 0.93 (95% CI, 0.91–0.95) for ABVS and 0.90 (95% CI, 0.88–0.92) for HHUS, and the specificity was 0.86 (95% CI, 0.83–0.88) for ABVS and 0.82 (95% CI, 0.79–0.84) for HHUS. (A) Sensitivity for ABVS; (B) specificity for ABVS; (C) sensitivity for HHUS; and (D) specificity for HHUS. ABVS, automated breast volume scanner; HHUS, hand-held ultrasound.

Figure 4

The pooled DOR for ABVS and HHUS. The pooled DOR was 88.66 (95% CI, 51.44–152.78) for ABVS and 41.06 (95% CI, 26.58–63.42). (A) The DOR for ABVS and (B) the DOR for HHUS. ABVS, automated breast volume scanner; HHUS, hand-held ultrasound; DOR, diagnostic odds ratio.

Figure 5

The AUC of the SROC and the Q* index for ABVS and HHUS. The AUC of the SROC was 0.9496 for ABVS and 0.9143 for HHUS, and the Q* index was 0.8899 for ABVS and 0.8469 for HHUS. (A) The SROC for ABVS; (B) the SROC for HHUS; and (C) the SROC for ABVS and HHUS combined in one figure. ABVS, automated breast volume scanner; HHUS, hand-held ultrasound; SROC, summary receiver operating characteristic.

Figure 6

Funnel plot for ABVS and HHUS. (A) The funnel plot for ABVS and (B) the funnel plot for HHUS. ABVS, automated breast volume scanner; HHUS, hand-held ultrasound.

Figure 7

The pooled detection rate for ABVS and HHUS. The pooled detection rate was 1.00 (95% CI, 1.00–1.00) for both ABVS and HHUS. (A) The pooled detection rate for ABVS and (B) the pooled detection rate for HHUS. ABVS, automated breast volume scanner; HHUS, hand-held ultrasound.

Figure 8

Funnel plot of 13 studies included in the detection rate analysis. (A) The funnel plot for ABVS and (B) the funnel plot for HHUS. ABVS, automated breast volume scanner; HHUS, hand-held ultrasound.

Figure S1

The pooled sensitivity was 0.91 (95% CI, 0.90–0.93) for ABVS and 0.91 (95% CI, 0.90–0.93) for HHUS, and the specificity was 0.82 (95% CI, 0.81–0.84) for ABVS and 0.78 (95% CI, 0.77–0.80) for HHUS. (A) Sensitivity for ABVS; (B) specificity for ABVS; (C) sensitivity for HHUS; (D) specificity for HHUS.

Figure S2

The pooled DOR was 56.59 (95% CI, 39.20–81.70) for ABVS and 41.21 (95% CI, 28.09–60.47) for HHUS. (A) DOR for ABVS; (B) DOR for HHUS.

Figure S3

The AUC of the SROC was 0.9426 for ABVS and 0.9269 for HHUS, and the Q* index and 0.8808 for ABVS and 0.8614 for HHUS. (A) SROC for ABVS; (B) SROC for HHUS.