Jun Fu, Yanyan Li, Na Li, Zhanzhan Li

Three-dimensional (3-D) ultrasound is commonly used for screening breast cancer; however, the diagnostic accuracy of this method is unknown. Here, we performed a systematic search on the literature to assess the clinical utility of 3-D ultrasound in benign and malignant breast masses. We conducted searches in several online databases covering all publications prior to August 15, 2017. The bivariate random effects model was used to assess the overall sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and summary area under receiver operating curve (AUC) with their corresponding 95% CI. The overall sensitivity of 3-D ultrasound for diagnosing benign and malignant breast masses was 89% (95% CI, 83%-93%) and the specificity was 88% (95% CI, 83%-92%) with high heterogeneity (I2=81.9; 95% CI, 74.4-89.3, P<0.001). Other parameters used to assess efficacy included PLR (5.57; 95% CI, 3.73-8.31), NLR (0.18; 95% CI, 0.11-0.28), and DOR (31.33; 95% CI, 15.19-64.61). The use of a Fagan diagram with a pretest probability of 20% yields a post-test probability of 65% with a PLR of 7. True post-test probability was calculated at 3%, with an NLR of 0.13. The summary receiver operating characteristic curve was 0.94 (95% CI, 0.92-0.96), with no evidence of publication bias. Three-dimensional ultrasound offers high sensitivity and specificity, with a high AUC, indicating a strong diagnostic value for detecting benign and malignant breast masses. Three-dimensional ultrasound may therefore represent an excellent option for secondary analysis of unclear breast lesions.