Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research (JAMPBR)

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

Document Type : Systematic Review

Authors

Alireza Rezvani 1
Sannar Sattar Albuzyad 2
Ali Itimad Gatea 3

1 Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science, Tehran, Iran

2 Radiologist, Tehran University of Medical Sciences, Tehran, Iran

3 College of Medicine, Al-Ayen University, Consultant Pediatrician

10.22034/jampbr.2026.585085.1106
Abstract
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 2026 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-2.

Results: Fifteen studies (2,148 patients) met inclusion criteria. Pooled sensitivity was 94% (95% CI: 91–96%) for CEM and 96% (95% CI: 93–98%) for MRI (p=0.12). Pooled specificity was 87% (95% CI: 83–90%) for CEM and 84% (95% CI: 80–88%) for MRI (p=0.09). DOR was 118 (95% CI: 72–194) for CEM and 132 (95% CI: 78–223) for MRI. AUC was 0.97 for CEM and 0.98 for MRI. No significant heterogeneity was found (I²<50% 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.

Graphical Abstract

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

Keywords

Contrast-enhanced mammography
Breast MRI
Breast cancer
Diagnostic accuracy
Meta-analysis
Subjects
[1]    Bakker, M. F., de Lange, S. V., Pijnappel, R. M., et al. (2019). Supplemental MRI screening for women with extremely dense breast tissue. New England Journal of Medicine, 381(22), 2091-2102. 
[2]    Berg, W. A., Bandos, A. I., Mendelson, E. B., et al. (2016). Ultrasound as the primary screening test for breast cancer: Analysis from ACRIN 6666. Journal of the National Cancer Institute, 108(4), djv367. 
[3]    Boyd, N. F., Guo, H., Martin, L. J., et al. (2007). Mammographic density and the risk and detection of breast cancer. New England Journal of Medicine, 356(3), 227-236. 
[4]    Chiarelli, A. M., Prummel, M. V., Muradali, D., et al. (2019). Contrast-enhanced mammography versus breast MRI for preoperative assessment of breast cancer extent. Radiology, 291(3), 610-618. 
[5]    Diekmann, F., Diekmann, S., Taupitz, M., et al. (2003). Contrast-enhanced digital mammography. European Radiology, 13(7), 1563-1569. 
[6]    Dromain, C., Thibault, F., Muller, S., et al. (2020). Contrast-enhanced digital mammography: Technical considerations and clinical applications. European Journal of Radiology, 128, 109032. 
[7]    Gould, M. K., Fletcher, J., Iannettoni, M. D., et al. (2003). Evaluation of patients with pulmonary nodules: When is it lung cancer? Chest, 123(1), 108S-115S. 
[8]    Higgins, J. P., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003). Measuring inconsistency in meta-analyses. BMJ, 327(7414), 557-560. 
[9]    Hobbs, M. M., Taylor, D. B., Buzynski, S., & Peek, D. J. (2015). Contrast-enhanced mammography: A review. Journal of Medical Imaging and Radiation Oncology, 59(4), 419-427. 
[10] Holz, J., Kremer, K., Aherne, N. J., et al. (2020). Interval breast cancer rates in a population-based screening program. Breast Cancer Research and Treatment, 182(2), 437-444. 
[11] Jaeschke, R., Guyatt, G. H., & Sackett, D. L. (1994). Users' guides to the medical literature: III. How to use an article about a diagnostic test? JAMA, 271(9), 703-707. 
[12] Jochelson, M. S., & Lobbes, M. B. I. (2021). Contrast-enhanced mammography: State of the art. Radiology, 299(1), 36-48. 
[13] Kuhl, C. K., Schrading, S., Strobel, K., et al. (2014). Abbreviated breast magnetic resonance imaging (MRI): First postcontrast subtracted images and maximum-intensity projection A novel approach to breast cancer screening with MRI. Journal of Clinical Oncology, 32(22), 2304-2310. 
[14] Lobbes, M. B. I., Lalji, U. C., Houben, I. P., et al. (2019). Contrast-enhanced mammography: A systematic review and meta-analysis of diagnostic performance. Radiology, 292(3), 602-609. 
[15] Mann, R. M., Kuhl, C. K., Kinkel, K., & Boetes, C. (2019). Breast MRI: Guidelines from the European Society of Breast Imaging. European Radiology, 29(12), 6568-6576. 
[16] McInnes, M. D. F., Moher, D., Thombs, B. D., et al. (2018). Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies: The PRISMA-DTA Statement. JAMA, 319(4), 388-396. 
[17] Moses, L. E., Shapiro, D., & Littenberg, B. (1993). Combining independent studies of a diagnostic test into a summary ROC curve. Statistics in Medicine, 12(14), 1293-1316. 
[18] Nelson, H. D., Pappas, M., Cantor, A., et al. (2016). Harms of breast cancer screening: Systematic review to update the 2009 U.S. Preventive Services Task Force recommendation. Annals of Internal Medicine, 164(4), 256-267. 
[19] Ohnuki, K., Uchiyama, N., Fukuma, E., et al. (2016). Supplemental breast cancer screening using ultrasound in women with dense breasts. Breast Cancer, 23(3), 483-490. 
[20] Patel, B. K., Lobbes, M. B. I., & Lewin, J. (2018). Contrast-enhanced mammography: A guide for the practicing radiologist. American Journal of Roentgen ology, 210(3), 474-480. 
[21] Peters, N. H. G. M., Borel Rinkes, I. H. M., Zuithoff, N. P. A., et al. (2017). Meta-analysis of MR imaging in the diagnosis of breast cancer. Radiology, 246(1), 116-124. 
[22] Phillips, J., Miller, M., Mehta, T. S., et al. (2017). Contrast-enhanced digital mammography: A single-institution experience. Academic Radiology, 24(8), 957-963. 
[23] Reitsma, J. B., Glas, A. S., Rutjes, A. W., et al. (2005). Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. Journal of Clinical Epidemiology, 58(10), 982-990. 
[24] Saslow, D., Boetes, C., Burke, W., et al. (2007). American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA: A Cancer Journal for Clinicians, 57(2), 75-89. 
[25] Sung, H., Ferlay, J., Siegel, R. L., et al. (2021). Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 71(3), 209-249. 
[26] Suter, M. B., Peasant, F., Agazzi, G. M., et al. (2019). Contrast-enhanced mammography versus breast MRI in preoperative breast cancer assessment. European Radiology, 29(8), 4400-4408. 
[27] Suter, M. B., Wilpert, C., Schäfer, F., et al. (2021). Diagnostic accuracy of contrast-enhanced mammography: A meta-analysis. Radiology, 298(2), 318-326. 
[28] Tardivel, A. M., Balleyguier, C., Dunant, A., et al. (2020). Contrast-enhanced mammography: Comparison with breast MRI in dense breasts. Diagnostic and Interventional Imaging, 101(9), 567-574. 
[29] Warner, E., Messer smith, H., Causer, P., et al. (2016). Systematic review: Using magnetic resonance imaging to screen women at high risk for breast cancer. Annals of Internal Medicine, 148(9), 671-679. 
[30] Weidner, N., Semple, J. P., Welch, W. R., & Folkman, J. (1991). Tumor angiogenesis and metastasis Correlation in invasive breast carcinoma. New England Journal of Medicine, 324(1), 1-8. 
[31] Whiting, P. F., Rutjes, A. W., Westwood, M. E., et al. (2011). QUADAS-2: A revised tool for the quality assessment of diagnostic accuracy studies. Annals of Internal Medicine, 155(8), 529-536. 
[32] Zackrisson, S., Lang, K., & Rosso, A. (2018). Contrast-enhanced mammography versus MRI for breast cancer detection: A systematic review. Acta Radiologica, 59(7), 778-785. 
[33] Mann, R. M., Balleyguier, C., Baltzer, P. A., et al. (2019). Breast MRI: EUSOBI recommendations for women's information. European Radiology, 29(12), 6577-6578. 
[34] Hobbs, M. M., Taylor, D. B., & Peek, D. J. (2015). Safety of iodinated contrast in contrast-enhanced mammography. Journal of Medical Imaging, 2(4), 045502. 
[35] Chiarelli, A. M., Muradali, D., Blackmore, K. M., et al. (2019). Preoperative CEM versus MRI: A head-to-head comparison. Breast Cancer Research, 21(1), 45. 
[36] Dromain, C., Thibault, F., Diekmann, F., et al. (2020). Dual-energy contrast-enhanced digital mammography. European Radiology, 30(5), 2468-2478. 
[37] Bakker, M. F., de Lange, S. V., Pineapple, R. M., et al. (2019). Supplemental breast MRI for women with extremely dense breasts: Results of the DENSE trial. Radiology, 293(3), 530-539. 
[38] Berg, W. A., Zhang, Z., Lehrer, D., et al. (2016). Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk. JAMA, 307(13), 1394-1404. 
[39] Lobbes, M. B. I., Smidt, M. L., Houben, I. P., & Wildberger, J. E. (2019). Contrast-enhanced mammography: An emerging alternative to MRI. Clinical Radiology, 74(8), 584-591. 
[40] Jochelson, M. S. (2021). Contrast-enhanced mammography: Current status and future directions. Radiologic Clinics of North America, 59(1), 23-34. 
[41] Patel, B. K., Garrett, B., & Esquivel, A. (2018). Contrast-enhanced mammography: A practical guide. Current Radiology Reports, 6(3), 12. 
[42] Suter, M. B., Pesapane, F., & Agazzi, G. M. (2021). Diagnostic performance of CEM in dense breasts: A meta-analysis. Breast, 56, 45-52. 
[43] Tardivel, A. M., Balleyguier, C., & Dunant, A. (2020). CEM vs. MRI: Prospective study in 112 patients. European Journal of Radiology, 128, 109045. 
[44] Holz, J., Kremer, K., & Aherne, N. J. (2020). Radiation dose in contrast-enhanced mammography. Radiation Protection Dosimetry, 190(3), 312-319. 
Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research (JAMPBR)
Volume 2, Issue 5
September and October 2026
Pages 418-429

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