Abbreviated versus full diagnostic protocol MRI for breast cancer detection: a diagnostic test accuracy systematic...

To systematically compare the diagnostic accuracy of abbreviated breast MRI (AB-MRI) and full diagnostic protocol MRI (FDP-MRI) for breast cancer detection.

Ovid-MEDLINE, Embase, Cochrane Library, and Web of Science were searched up to December 1, 2025. Risk of bias was assessed using the modified Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool.

Forty studies (14,266 patients) were included. In screening settings, the first postcontrast subtracted (FAST) protocol achieved sensitivity comparable to FDP‑MRI but significantly lower specificity; adding T2‑weighted (T2W) imaging raised specificity to a level not statistically different from FDP‑MRI. In enriched‑screening settings, FAST with or without T2W performed comparably. In diagnostic settings, FAST combined with ultrafast (UF) and T2W demonstrated significantly higher specificity than FDP‑MRI (ratio 1.61, p < 0.001), while FAST and rapid abridged multiphase (RAMP) with or without T2W or diffusion‑weighted imaging (DWI) were comparable to FDP‑MRI. T2W + DWI alone showed significantly reduced sensitivity in diagnostic settings.

The diagnostic performance of AB‑MRI protocols relative to FDP‑MRI varies by protocol and clinical setting; findings apply only to the specific regimens evaluated. FAST maintains high sensitivity, with T2W offsetting specificity limitations in screening, while FAST + UF + T2W offers superior specificity in diagnostic settings. However, most subgroup analyses included only 3-4 studies, and others fewer than three; all results therefore require cautious interpretation and validation in larger, prospective studies before clinical adoption.