Value of shear wave elastography in evaluating response to neoadjuvant chemotherapy in breast cancer: A systematic review and meta-analysis

Abstract

Objective To determine how well shear wave elastography performs as a diagnostic tool for determining the pathological response to neoadjuvant chemotherapy in breast cancer. Methods Through April 2025, a systematic search of PubMed, MEDLINE, Cochrane Library, China National Knowledge Infrastructure, and SinoMed was used to perform a diagnostic meta-analysis. Included were studies of individuals with breast cancer receiving neoadjuvant chemotherapy with shear wave elastography evaluation. The diagnostic performance of shear wave elastography was assessed using a hierarchical summary receiver operating characteristic model and a bivariate random-effects model. The Quality Assessment of Diagnostic Accuracy Studies-2 was used to evaluate the quality of the study. Results The study includes 15 trials with 1402 patients. For predicting pathological response to neoadjuvant chemotherapy, the pooled sensitivity and specificity of shear wave elastography were 0.68 (95% confidence intervals: 0.49–0.86) and 0.73 (95% confidence intervals: 0.60–0.87), respectively. 13.06 (95% confidence intervals: 8.42–20.25) was the pooled diagnostic odds ratio. The hierarchical summary receiver operating characteristic study showed a moderate diagnostic performance with an area under the curve of 0.85 (95% confidence intervals: 0.82–0.88). Conclusions Shear wave elastography may be a helpful supplementary imaging modality in clinical treatment monitoring and showed moderate diagnostic performance for assessing pathological response to neoadjuvant chemotherapy in breast cancer. To confirm its clinical value, more extensive prospective investigations are required. PROSPERO registration number: CRD420261435666.