Diagnostic accuracy of contrast-enhanced spectral mammography for breast lesions: A systematic review and meta-analysis

Abstract

Breast cancer diagnosis and staging is based on mammography, ultrasound, and magnetic resonance imaging (MRI). Contrast enhanced spectral mammography (CESM) has gained momentum as an innovative and clinically useful method for breast assessment. CESM is based on abnormal enhancement of neoplastic tissue compared to surrounding breast tissue. We performed a systematic review of prospective trial to evaluate its diagnostic performance, following standard PRISMA-DTA. We used a bivariate random-effects regression approach to obtain summary estimates of both sensitivity and specificity of CESM. 8 studies published between 2003 and 2019 were included in the meta-analysis for a total of 945 lesions. The summary area under the curve obtained from all the study was 89% [95% CI 86%–91%], with a sensitivity of 85% [95% CI 73%–93%], and a specificity of 77% [95% CI 60%–88%]. With a pre-test probability of malignancy of 57% a positive finding at CESM gives a post-test probability of 83% while a negative finding a post-test probability of 20%. CESM shows a suboptimal sensitivity and specificity in the diagnosis of breast cancer in a selected population, and at present time, it could be considered only as a possible alternative test for breast lesions assessment when mammography and ultrasound are not conclusive or MRI is contraindicated or not available.

Contrast-enhanced Mammography: State of the Art

“…Results suggest that CEM is more sensitive than FFDM alone, more sensitive than FFDM plus US, and more specific than FFDM plus US (24,41,42). The sensitivity of CEM approaches that of breast MRI, and CEM is likely more specific (44). Currently, the total number of patients studied thus far is small.…”

Supplemental screening using breast MRI in women with mammographically dense breasts

“…Kaiser and colleagues find supplemental screening test sensitivity and specificity as least important factors on cost-effectiveness [1]. However, their paper does neither address sensitivity and specificity levels as low as reported by Suter and colleagues for CEM [44] nor do they address different costs associated with different image-guided biopsies. CEM-guided biopsy procedures are mainly under development and far from being state of the art, but would be required when employing CEM as a screening test.…”

“…The lack of representative single study data calls for a systematic review and meta-analysis. A recent meta-analysis estimated pooled sensitivity and specificity of CEM as 85 % (95 %-CI: 73-93 %) and 77 % (95 %-CI: 60-88 %) and pointed out the presence of small study effect bias [44]. Breast MRI data compare favourably to this, reporting pooled sensitivity and specificity of 99 % (95 % CI: 93-100 %) and 89 % (95 %-CI: 85-92 %) in patients without mammographic microcalcifications (no publication bias and no heterogeneity regarding sensitivity and NPV) [45].…”

Künstliche Intelligenz in der Mammadiagnostik

“…Selbst bei guter Verfügbarkeit von Magnetresonanztomographien ist eine Verzögerung des Managements von zumindest Stunden, wahrscheinlicher Tagen zu erwarten. Gerade deshalb erfreut sich die Kontrastmittel-Mammographie trotz klar unterlegener diagnostischer Aussagekraft großer Beliebtheit [ 24 , 25 ]. Nicht zu unterschätzen sind auch multiparametrische Ultraschallverfahren [ 26 ].…”