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Review
. 2022 Aug 4;12(8):1890.
doi: 10.3390/diagnostics12081890.

Contrast-Enhanced Mammography versus Breast Magnetic Resonance Imaging: A Systematic Review and Meta-Analysis

Fabrizia Gelardi  1   2 , Elisa Maria Ragaini  1 , Martina Sollini  1   2 , Daniela Bernardi  1   2 , Arturo Chiti  1   2
Affiliations
Review

Contrast-Enhanced Mammography versus Breast Magnetic Resonance Imaging: A Systematic Review and Meta-Analysis

Fabrizia Gelardi et al. Diagnostics (Basel). .

Abstract

Background: Contrast-enhanced mammography (CEM) and contrast-enhanced magnetic resonance imaging (CE-MRI) are commonly used in the screening of breast cancer. The present systematic review aimed to summarize, critically analyse, and meta-analyse the available evidence regarding the role of CE-MRI and CEM in the early detection, diagnosis, and preoperative assessment of breast cancer.

Methods: The search was performed on PubMed, Google Scholar, and Web of Science on 28 July 2021 using the following terms "breast cancer", "preoperative staging", "contrast-enhanced mammography", "contrast-enhanced spectral mammography", "contrast enhanced digital mammography", "contrast-enhanced breast magnetic resonance imaging" "CEM", "CESM", "CEDM", and "CE-MRI". We selected only those papers comparing the clinical efficacy of CEM and CE-MRI. The study quality was assessed using the QUADAS-2 criteria. The pooled sensitivities and specificity of CEM and CE-MRI were computed using a random-effects model directly from the STATA "metaprop" command. The between-study statistical heterogeneity was tested (I2-statistics).

Results: Nineteen studies were selected for this systematic review. Fifteen studies (1315 patients) were included in the metanalysis. Both CEM and CE-MRI detect breast lesions with a high sensitivity, without a significant difference in performance (97% and 96%, respectively).

Conclusions: Our findings confirm the potential of CEM as a supplemental screening imaging modality, even for intermediate-risk women, including females with dense breasts and a history of breast cancer.

Keywords: breast cancer; contrast-enhanced breast magnetic resonance imaging; contrast-enhanced mammography; screening.

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Conflict of interest statement

Chiti reports a fellowship grant from Sanofi, personal fees from AAA, Blue Earth Diagnostics and General Electric Healthcare, outside the submitted work. The other authors do not report any conflict of interest.

Figures

Figure 1
Figure 1
Assessment of the risk of bias (a) and the applicability (b) through the QUADAS-2 score.
Figure 2
Figure 2
Forest plot of the estimated pooled sensitivity of breast CE-MRI (a) and CME (b) in the detection of pathological breast lesions, including index and secondary lesions. The estimated pooled sensitivity of CE-MRI (a) was 0.96 (95% CI 0.93–0.98), with a moderate heterogeneity (I2 = 72.02% p = 0.001). The estimated pooled sensitivity of CME (b) was 0.96 (95% CI 0.93–0.99), with a high heterogeneity (I2 = 83.06% p = 0.001) [16,17,18,19,21,22,23,24,25,26,28,29,30,33,34].
Figure 3
Figure 3
Funnel plot with 95% CIs for publication bias assessment of pooled sensitivity of CE-MRI (a) and CEM (b) in the detection of pathological breast lesions (considering both index and secondary lesions).
Figure 4
Figure 4
Forest plot of the estimated pooled sensitivity of breast CE-MRI (a) and CME (b) in the detection of pathological breast index lesions. The estimated pooled sensitivity of CE-MRI (a) was 0.96 (95% CI 0.94–0.98), with a moderate heterogeneity (I2 = 61.63% p = 0.001). Estimated pooled sensitivity of CME (b) was 0.97 (95% CI 0.95–0.99), with a moderate heterogeneity (I2 = 72.05% p = 0.001) [16,17,18,19,21,22,23,24,25,26,28,29,30,33,34].
Figure 5
Figure 5
Funnel plot with 95% CIs for publication bias assessment of the pooled sensitivity of CE-MRI (a) and CEM (b) for the detection of pathological breast index lesions.
Figure 6
Figure 6
Forest plot of the estimated pooled sensitivity of breast CE-MRI (a) and CME (b) for the differential diagnosis of suspicious lesions at screening. The estimated pooled sensitivity of CE-MRI (a) was 0.95 (95% CI 0.91–0.98), with a moderate heterogeneity (I2 = 67.75% p = 0.001). The estimated pooled sensitivity of CME (b) was 0.98 (95% CI 0.93–1.00), with a high heterogeneity (I2 = 76.46% p = 0.001) [16,17,18,21,28,29,30].
Figure 7
Figure 7
Forest plot of the estimated pooled sensitivity of breast CE-MRI (a) and CME (b) in preoperative staging. The estimated pooled sensitivity of CE-MRI (a) was 0.97 (95% CI 0.95–0.99), with a moderate heterogeneity (I2 = 42.49% p = 0.01). The estimated pooled sensitivity of CME (b) was 0.97 (95% CI 0.94–0.99), with a moderate heterogeneity (I2 = 69.81% p = 0.10) [19,22,23,24,25,26,33,34].
Figure 8
Figure 8
Funnel plot with 95% CIs for publication bias assessment of the pooled sensitivity of CE-MRI (a) and CEM (b) for the differential diagnosis of suspicious lesions at screening.
Figure 9
Figure 9
Funnel plot with 95% CIs for publication bias assessment for the pooled sensitivity of CE-MRI (a) and CEM (b) in preoperative staging.
Figure 10
Figure 10
Forest plot of the estimated pooled sensitivity of breast CE-MRI (a) and CME (b) in the detection of pathological breast lesions in women with dense breasts. The estimated pooled sensitivity of CE-MRI was 0.98 (95% CI 0.91–1.00; I2 = 78.96% p = 0.001). The estimated pooled sensitivity of CEM was 0.99 (95% CI 0.92–1.00;I2= 85.89% p = 0.001) [16,22,33].
Figure 11
Figure 11
Funnel plot with 95% CIs for publication bias assessment of pooled sensitivity for CE-MRI (a) and CEM (b) for the detection of pathological breast lesions in women with dense breasts.
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