Contrast mammography or contrast MRI, which is best for breast cancer diagnosis? Study sheds light

Austria: Contrast-enhanced MRI (CE-MRI) and contrast-enhanced mammography (CEM) showed comparable performance for identifying breast cancer, however, CE-MRI demonstrated superior sensitivity, according to a recent study in Radiology. 

In breast imaging, contrast-enhanced mammography is a more accessible alternative to contrast-enhanced MRI, but there is a lack of a summary comparison of published studies. To fill this knowledge gap, Pascal A. T. Baltzer, the Medical University of Vienna and General Hospital, Vienna, Austria, and colleagues set out to make a direct comparison of the performance of CEM and CE-MRI regarding sensitivity, specificity, and negative predictive value in detecting breast cancer.

Characteristics of studies investigating the comparative diagnostic performance of CEM and CE-MRI in detecting breast cancer were extracted by two readers. Studies published until April 2021 were eligible. Bivariate random effects models were used to calculate specificity, sensitivity, negative predictive value, and positive and negative likelihood ratios. 

A Fagan nomogram was utilized to identify the maximum pretest probability at which posttest probabilities of a negative CEM or CE-MRI examination were in line with the 2% malignancy rate benchmark for downgrading a Breast Imaging Reporting and Data System (BI-RADS) category 4 to a BI-RADS category 3 results.