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The objective of this study was to systematically review and evaluate the diagnostic accuracy of contrast-enhanced ultrasound
(CEUS) in differential diagnosis of benign and malignant breast lesions. The scientific literature databases PubMed and Embase
were comprehensively searched for relevant studies before January 2015. Data were pooled to yield summary sensitivity, specificity,
positive likelihood ratios (PLR), negative likelihood ratios (NLR), and diagnostic odds ratio (DOR) using Meta-Disc Version 1.4
software. A total of 31 studies with 2395 lesions were considering eligible following predefined criteria. The pooled sensitivity,
specificity and DOR was 0.88 (95% CI, 0.86-0.90) and 0.80 (95% CI, 0.78-0.82), respectively. The pooled positive and negative
likelihood radios was 4.18 (95% CI, 3.01-5.80), and 0.16 (95% CI, 0.11-0.24), respectively. The pooled DOR of was 30.36 (95% CI,
16.41-56.14) and the area under the curve (AUC) of SROC was 0.9136 (standard error: 0.0226). In the subgroup analysis, the pooled
results of real time gray scale or harmonic modality with second generation contrast agents groups were significant better than
other groups. All subgroup analysis did not diminish the heterogeneity due to variability in study factors. There was no significant
publication bias according to Deeks� funnel plot asymmetry test. In conclusion, the comprehensive results suggested that CEUS could
be a potential reliable method for differential diagnosis of benign and malignant breast lesions, the second generation contrast agents
increase diagnostic accuracy of CEUS and real time gray scale and harmonic modality could be more suitable to perform CEUS.