DIAGNOSTIC ACCURACY OF CONTRAST-ENHANCED MAMMOGRAPHY VERSUS BREAST MRI IN BREAST CANCER DETECTION: A SYSTEMATIC REVIEW

Abstract

Background: Breast cancer is the most frequently diagnosed form of cancer among women, and a primary source of cancer related death globally. Contrast-enhanced magnetic resonance imaging (MRI) of the breast is considered the most sensitive method of detecting breast cancer by medical imaging at this time, but its high cost, long acquisition time, limited availability in certain areas, and various contraindications (e.g., metal implants) hinder its routine application. Contrast-enhanced mammography (CEM) has emerged as an alternative to MRI for breast cancer detection that allows for faster and more accessible detection of breast cancer with simultaneous acquisition of both morphology and function in one examination. Objective: The purpose of this study was to conduct a systematic review and comparison of the diagnostic performance of CEM with that of contrast-enhanced breast MRI for the detection of breast cancer in adult women with regard to sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Methods: We performed a systematic review of the literature on the comparison of contrast-enhanced mammography (CEM) and magnetic resonance imaging (MRI) as imaging modalities used to evaluate breast cancer. Our review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. We included original studies that directly compared CEM and MRI in the same patient cohort with histopathological diagnosis or at least 12 months of follow-up imaging for inclusion into the systematic review. Screening of included studies, data extraction, and evaluation of study quality was performed independently by two reviewers using the QUADAS-2 tool. The diagnostic performance metrics were obtained or calculated from the corresponding two-by-two tables extracted from the studies. Results: Eight studies (1,847 patients and 2,135 lesions) met eligibility criteria; the range of reported sensitivities (89-97% CEM vs. 91-99% MRI), specificities (78-87% CEM vs. 81-91% MRI), PPVs (83-89% CEM vs. 87-92% MRI), and NPVs (88-94% CEM vs. 92-97% MRI). MRI provided slightly higher overall sensitivity than CEM while CEM provided comparable or, in some cases, greater specificity than MRI. The gap in performance between CEM and MRI was minimized for masses and dense breasts, whereas the gap was greatest for non-mass enhancement (NME) lesions, in which case MRI was superior. Conclusion: CEM is a highly accurate test for diagnosing invasive breast cancer and is comparable to breast MRI. While MRI has the highest sensitivity of any breast imaging modality and is, therefore, the gold standard in breast imaging, CEM is an effective alternative in cases where MRI cannot be performed or is unavailable due to cost, speed, and widespread access relative to MRI. Standardised protocols for CEM acquisition and interpretation, as well as multicentre prospective studies to determine CEM's definitive clinical role, are required.