Diagnostic Performance of Contrast-Enhanced Mammography Versus Breast MRI for Detecting Breast Cancer: A Systematic Review and Meta-Analysis

Background: Contrast-enhanced mammography (CEM) is an emerging alternative to breast magnetic resonance imaging (MRI) for detecting breast cancer, offering lower cost and shorter acquisition time. However, comparative diagnostic accuracy remains uncertain.Objective: To compare the diagnostic performance of CEM versus breast MRI for breast cancer detection using a systematic review and meta-analysis.Methods: We searched PubMed, Scopus, and Web of Science up to January ۲۰۲۶ for studies reporting sensitivity and specificity of both CEM and MRI in the same population, using histopathology or follow-up as reference standard. We calculated pooled sensitivity, specificity, diagnostic odds ratio (DOR), and area under the summary receiver operating characteristic curve (AUC). Quality was assessed using QUADAS-۲.Results: Fifteen studies (۲,۱۴۸ patients) met inclusion criteria. Pooled sensitivity was ۹۴% (۹۵% CI: ۹۱–۹۶%) for CEM and ۹۶% (۹۵% CI: ۹۳–۹۸%) for MRI (p=۰.۱۲). Pooled specificity was ۸۷% (۹۵% CI: ۸۳–۹۰%) for CEM and ۸۴% (۹۵% CI: ۸۰–۸۸%) for MRI (p=۰.۰۹). DOR was ۱۱۸ (۹۵% CI: ۷۲–۱۹۴) for CEM and ۱۳۲ (۹۵% CI: ۷۸–۲۲۳) for MRI. AUC was ۰.۹۷ for CEM and ۰.۹۸ for MRI. No significant heterogeneity was found (I²<۵۰% for most analyses).Conclusion: CEM demonstrates comparable diagnostic accuracy to breast MRI for breast cancer detection, with slightly lower sensitivity but similar specificity. CEM may serve as an accessible alternative where MRI is unavailable or contraindicated.

کلیدواژه ها:

Contrast-enhanced mammography ، Breast MRI ، breast cancer ، Diagnostic accuracy ، Meta-analysis