Diagnostic accuracy of automated breast volume scanning, hand-held ultrasound and molybdenum-target mammography for breast lesions: a systematic review and meta-analysis

Abstract

Background: Given the high incidence and increasing burden of breast cancer, more approaches are needed to improve the early diagnosis of breast cancer. The three mainstream diagnostic methods, automated breast volume scanning (ABVS), hand-held ultrasound (HHUS) and mammography, are still controversial in their diagnostic accuracy. The aim of this study is to systematically evaluate the accuracy of three diagnostic methods.

Methods: PubMed, Embase, Web of Science, The Cochrane Library, Wanfang Data, China National Knowledge Infrastructure (CNKI), VIP and SinoMed databases were searched by computer. Studies on the accuracy of ABVS, HHUS and mammography in the diagnosis of benign and malignant breast lesions were collected, and the search time limit was from the establishment of the database to August 2022. The Chi-square test was then performed using Meta-Disc software, and the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used for bias and quality assessment.

Results: A total of 31 studies involving 8,107 benign or malignant lesion were included in the meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under curve for HHUS were 0.86 (0.84, 0.87), 0.80 (0.78, 0.81), 4.20 (3.53, 4.99), 0.20 (0.16, 0.24), 22.88 (16.84, 31.08) and 0.898, respectively. And those for ABVS were 0.90 (0.89, 0.91), 0.87 (0.86, 0.88), 7.93 (5.05, 12.45), 0.11 (0.09, 0.15), 74.63 (45.37, 122.76) and 0.956, respectively. And those for molybdenum-target mammography were 0.81 (0.78, 0.84), 0.90 (0.88, 0.91), 6.94 (4.32, 11.17), 0.23 (0.18, 0.29), 31.41 (17.01, 57.98) and 0.887, respectively. Indicators related to patient selection and reference standards suggested a high risk of bias in several included studies.

Conclusions: Meta-analysis found a higher diagnostic accuracy of ABVS in benign and malignant breast lesions. These results provide a reference for clinical practitioners in the selection of diagnostic methods, but considering the possible bias of the included studies, the results need to be treated with caution and further verified.

Keywords: Breast cancer; automated breast volume scanning (ABVS); hand-held ultrasound (HHUS); meta-analysis; molybdenum-target mammography.

Figure 1

Study flow diagram. A diagram summarizing the search and screening process of the included studies.

Figure 2

Forest plot of pooled DOR for HHUS in the diagnosis of breast cancer. DOR, diagnostic odds ratio; HHUS, hand-held ultrasound; 95% CI, 95% confidence interval.

Figure 3

Forest plot of pooled DOR for ABVS in the diagnosis of breast cancer. ABVS, automated breast volume scanning; DOR, diagnostic odds ratio; 95% CI, 95% confidence interval.

Figure 4

Forest plot of pooled DOR for molybdenum-target mammography in the diagnosis of breast cancer. DOR, diagnostic odds ratio; 95% CI, 95% confidence interval.