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Meta-Analysis
. 2020 Jun;11(6):1423-1432.
doi: 10.1111/1759-7714.13400. Epub 2020 Mar 31.

A meta-analysis of contrast-enhanced spectral mammography versus MRI in the diagnosis of breast cancer

Wanqing Xiang  1 , Haiying Rao  2 , Liyu Zhou  1
Affiliations
Meta-Analysis

A meta-analysis of contrast-enhanced spectral mammography versus MRI in the diagnosis of breast cancer

Wanqing Xiang et al. Thorac Cancer. 2020 Jun.

Abstract

Background: To identify the performance of contrast-enhanced spectral mammography (CESM) and magnetic resonance imaging (MRI) for breast cancer diagnosis by pooling the open published data.

Methods: A systematic review of studies relevant to CESM and MRI in the diagnosis of breast cancer were screened in the electronic databases of Pubmed, EMBASE, the Cochrane Library, Web of Science, Google scholar and CNKI. The methodical quality of the included publications was evaluated by the quality assessment of diagnostic accuracy studies-2 (QUADAS-2). The diagnostic sensitivity, specificity and area under the ROC curve (AUC) were pooled and the true positive (TP), false positive (FP), false negative (FN) and true negative (TN) of the original studies were calculated.

Results: A total of 13 diagnostic publications were identified and included in the meta-analysis. Of those included, five were retrospective studies and the remaining eight were prospective work. The combined data indicating the pooled sensitivity and specificity of CESM and MRI were 0.97 (95% CI: 0.95-0.98), 0.66 (95% CI: 0.59-0.71), 0.97 (95% CI: 0.95-0.98),and 0.52 (95% CI: 0.46-0.58), respectively. The pooled +LR and -LR for CESM were 2.70 (95% CI: 1.57-4.65), 0.06 (95% CI: 0.04-0.09), and 2.01 (95% CI: 1.78-2.26), 0.08 (95% CI: 0.05-0.11) for MRI, respectively. For the diagnostic odds ratio (DOR), the pooled results of CESM and MRI were 60.15 (95% CI: 24.72-146.37) and 31.34 (95% CI: 19.61-50.08), respectively. The AUC of the symmetric receiver operating characteristic curve (SROC) was 0.9794 and 0.9157 for CESM and MRI, respectively, calculated using the Moses model in the diagnosis of breast cancer.

Conclusions: Both CESM and MRI are effective methods for the detection of breast cancer with high diagnostic sensitivity. The diagnostic performance of CESM appears to be more effective than MRI.

Keywords: Contrast-enhanced spectral mammography; MRI; diagnosis breast cancer; meta-analysis.

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Figures

Figure 1
Figure 1
Study flowchart.
Figure 2
Figure 2
Quality evaluation of studies included in the meta‐analysis.
Figure 3
Figure 3
Forest plot of the pooled diagnostic sensitivity of CESM and MRI for breast cancer. (a) Forest plot of sensitivity of CESM in the diagnosis of breast cancer; (b) Forest plot of sensitivity of MRI in the diagnosis of breast cancer.
Figure 4
Figure 4
Forest plot of the pooled diagnostic specificity of CESM and MRI for breast cancer. (a) Forest plot of specificity of CESM in the diagnosis of breast cancer; (b) Forest plot of specificity of MRI in the diagnosis of breast cancer.
Figure 5
Figure 5
Forest plot of the pooled +LR of CESM and MRI for breast cancer. (a) Forest plot of +LR for CESM in the diagnosis of breast cancer; (b) Forest plot of +LR for MRI in the diagnosis of breast cancer.
Figure 6
Figure 6
Forest plot of the pooled –LR of CESM and MRI for breast cancer. (a) Forest plot of –LR for CESM in the diagnosis of breast cancer; (b) Forest plot of –LR for MRI in the diagnosis of breast cancer.
Figure 7
Figure 7
Forest plot of the pooled DOR of CESM and MRI for breast cancer. (a) Forest plot of DOR for CESM in the diagnosis of breast cancer; (b) Forest plot of DOR for MRI in the diagnosis of breast cancer.
Figure 8
Figure 8
The ROC curve of CESM and MRI for breast cancer diagnosis. (a) ROC curve for CESM in the diagnosis of breast cancer; (b) ROC curve for MRI in the diagnosis of breast cancer.
See this image and copyright information in PMC

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