Academic radiology · 2026
Contrast-Enhanced Mammography in the Work-up of Asymmetries: A Systematic Review and Meta-analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод в очереди
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Ferre Romuald, Benefield Thad, Kuzmiak Cherie M
Аннотация
RATIONALE AND OBJECTIVES: Contrast-enhanced mammography (CEM) is increasingly used to evaluate mammographic or digital breast tomosynthesis (DBT) detected asymmetries. We performed a systematic review and meta-analysis to estimate the diagnostic performance of CEM in this setting, focusing on the negative predictive value (NPV) of non-enhancing asymmetries.
MATERIALS AND METHODS: MEDLINE and Embase were searched through October 2025 for studies reporting outcomes of CEM in mammographic/DBT-detected asymmetries with histopathology and/or imaging follow-up. Study selection and data extraction were performed by two readers. Random-effects models with Hartung-Knapp adjustment were used for pooled estimates. Exact aggregated binomial confidence intervals were calculated for zero-event analyses. Risk of bias was assessed using QUADAS-2.
RESULTS: Four retrospective single-center studies met inclusion criteria. Across 147 non-enhancing asymmetries (NEAs) with definitive outcomes, no false-negative cancers were observed. Study-level NPVs were 100%. Random-effects pooling yielded an NPV of 0.98 (95% CI, 0.85-0.997; I² = 0%). Exact aggregated binomial analysis demonstrated an NPV of 100% with a conservative 95% lower bound of 97.5%. Enhancing asymmetries, particularly mass-type and suspicious non-mass enhancement, were strongly associated with malignancy. Accuracy and positive predictive value (PPV) varied by study setting and prevalence.
CONCLUSION: In appropriately selected mammographic/DBT asymmetries, absence of enhancement on CEM is associated with an extremely low malignancy risk and may support surveillance strategies, whereas enhancement markedly increases malignant probability and refines risk stratification.
MATERIALS AND METHODS: MEDLINE and Embase were searched through October 2025 for studies reporting outcomes of CEM in mammographic/DBT-detected asymmetries with histopathology and/or imaging follow-up. Study selection and data extraction were performed by two readers. Random-effects models with Hartung-Knapp adjustment were used for pooled estimates. Exact aggregated binomial confidence intervals were calculated for zero-event analyses. Risk of bias was assessed using QUADAS-2.
RESULTS: Four retrospective single-center studies met inclusion criteria. Across 147 non-enhancing asymmetries (NEAs) with definitive outcomes, no false-negative cancers were observed. Study-level NPVs were 100%. Random-effects pooling yielded an NPV of 0.98 (95% CI, 0.85-0.997; I² = 0%). Exact aggregated binomial analysis demonstrated an NPV of 100% with a conservative 95% lower bound of 97.5%. Enhancing asymmetries, particularly mass-type and suspicious non-mass enhancement, were strongly associated with malignancy. Accuracy and positive predictive value (PPV) varied by study setting and prevalence.
CONCLUSION: In appropriately selected mammographic/DBT asymmetries, absence of enhancement on CEM is associated with an extremely low malignancy risk and may support surveillance strategies, whereas enhancement markedly increases malignant probability and refines risk stratification.