Abstract
BACKGROUND: Neoadjuvant chemotherapy (NAC) is administered to specific subgroups of breast cancer patients to improve clinical outcomes. Achieving a pathological complete response (pCR) is strongly associated with improved survival. This meta-analysis systematically evaluated the diagnostic performance of shear wave elastography (SWE) and contrast-enhanced ultrasound (CEUS) in predicting the pathological response of breast cancer patients to NAC. METHODS: Relevant studies were searched in the databases of PubMed, Web of Science, and Embase until July 14, 2024. The articles were screened and relevant data were extracted, and study quality was assessed using Review Manager 5.4. The area under the curve (AUC) was calculated, and publication bias was evaluated by funnel plots generated using Stata 18.0. These analyses aimed to assess the diagnostic performance of SWE and CEUS in predicting the pathological response of breast cancer patients to NAC in terms of sensitivity (Sen) and specificity (Spe). RESULTS: A total of 22 studies comprising 1,725 breast cancer patients were included in the meta-analysis. The composite combined AUC, Sen, and Spe of CEUS in monitoring the pathological response of breast cancer patients to NAC were 0.86 [95% confidence interval (CI), 0.83-0.89], 0.88 (95% CI, 0.80-0.93), and 0.80 (95% CI, 0.74-0.84), respectively, and those of SWE were 0.88 (95% CI, 0.84-0.90), 0.82 (95% CI, 0.77-0.85), and 0.81 (95% CI, 0.74-0.86), respectively. CONCLUSIONS: This meta-analysis confirmed that CEUS and SWE had comparable Spe in predicting the pathological response of breast cancer patients to NAC (CEUS: 0.80 vs. SWE: 0.81), but CEUS had superior Sen (0.88 vs. 0.82). Both modalities have clinically relevant diagnostic value (AUC >0.80), supporting their utility in the non-invasive monitoring of NAC efficacy.