Contrast-enhanced Mammography versus Contrast-enhanced Breast MRI: A Systematic Review and Meta-Analysis.

Area of Science:

• Radiology and Imaging
• Oncology
• Medical Diagnostics

Background:

• Contrast-enhanced mammography (CEM) is a more accessible breast imaging alternative to contrast-enhanced MRI (CE-MRI).
• A comprehensive comparison of existing studies on CEM and CE-MRI performance is currently lacking.
• Evaluating diagnostic accuracy is crucial for effective breast cancer detection.

Purpose of the Study:

• To directly compare the diagnostic performance of CEM and CE-MRI in breast cancer detection.
• To evaluate sensitivity, specificity, and negative predictive value across published studies.
• To determine the utility of each modality in ruling out malignancy based on pretest probabilities.

Main Methods:

• Systematic review and meta-analysis of English-language studies comparing CEM and CE-MRI.
• Bivariate random effects models used to calculate diagnostic performance metrics (sensitivity, specificity, likelihood ratios).
• Fagan nomogram applied to assess the impact of test results on pretest probabilities for malignancy.

Main Results:

• Seven studies involving 1137 lesions were analyzed; no publication bias was detected.
• CE-MRI demonstrated higher sensitivity (97%) than CEM (91%) but lower specificity (69% vs. 74%).
• CE-MRI had a lower negative likelihood ratio (0.04 vs. 0.12), enabling malignancy exclusion at higher pretest probabilities (33% vs. 14%).

Conclusions:

• Contrast-enhanced MRI offers superior sensitivity and negative predictive performance compared to CEM.
• CE-MRI is more effective in ruling out breast cancer, especially at higher pretest probabilities.
• Iodine concentration impacts CEM performance, correlating positively with sensitivity and negatively with specificity.