From the Department of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna and General Hospital, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
Radiology. 2022 Oct;305(1):94-103. doi: 10.1148/radiol.212530. Epub 2022 Jun 7.
Background Contrast-enhanced mammography (CEM) is a more accessible alternative to contrast-enhanced MRI (CE-MRI) in breast imaging, but a summary comparison of published studies is lacking. Purpose To directly compare the performance of CEM and CE-MRI regarding sensitivity, specificity, and negative predictive value in detecting breast cancer, involving all publicly available studies in the English language. Materials and Methods Two readers extracted characteristics of studies investigating the comparative diagnostic performance of CEM and CE-MRI in detecting breast cancer. Studies published until April 2021 were eligible. Sensitivity, specificity, negative predictive value, and positive and negative likelihood ratios were calculated using bivariate random effects models. A Fagan nomogram was used 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 result. statistics, Deeks funnel plot asymmetry test for publication bias, and meta-regression were used. Results Seven studies investigating 1137 lesions (654 malignant, 483 benign) with an average cancer prevalence of 65.3% (range: 47.3%-82.2%) were included. No publication bias was found ( = .57). While the positive likelihood ratio was equal at a value of 3.1 for CE-MRI and 3.6 for CEM, the negative likelihood ratio of CE-MRI (0.04) was lower than that with CEM (0.12). CE-MRI had higher sensitivity for breast cancer than CEM (97% [95% CI: 86, 99] vs 91% [95% CI: 77, 97], respectively; < .001) but lower specificity (69% [95% CI: 46, 85] vs 74% [95% CI: 52, 89]; = .09). A Fagan nomogram demonstrated that the maximum pretest probability at which both tests could rule out breast cancer was 33% for CE-MRI and 14% for CEM. Furthermore, iodine concentration was positively associated with CEM sensitivity and negatively associated with its specificity ( = .04 and < .001, respectively). Conclusion Contrast-enhanced MRI had superior sensitivity and negative likelihood ratios with higher pretest probabilities to rule out malignancy compared with contrast-enhanced mammography. © RSNA, 2022 See also the editorial by Mann and Veldhuis in this issue.
背景 与对比增强磁共振成像（CE-MRI）相比，对比增强乳腺摄影（CEM）在乳腺成像中更容易获得，但缺乏对已发表研究的综合比较。目的 直接比较 CEM 和 CE-MRI 在检测乳腺癌方面的敏感性、特异性和阴性预测值，包括英语文献中所有公开的研究。材料与方法 两位读者提取了研究 CEM 和 CE-MRI 对比诊断性能的研究特征，以检测乳腺癌。合格的研究为截至 2021 年 4 月发表的研究。使用双变量随机效应模型计算敏感性、特异性、阴性预测值、阳性和阴性似然比。使用 Fagan 列线图确定最大术前概率，在此概率下，阴性 CEM 或 CE-MRI 检查的术后概率与将乳腺影像报告和数据系统（BI-RADS）分类 4 降级为 BI-RADS 分类 3 结果的 2%恶性率基准相符。使用统计检验、Deeks 漏斗图不对称检验和荟萃回归来检测发表偏倚。结果 纳入了 7 项研究共 1137 个病灶（654 个恶性，483 个良性），平均癌症患病率为 65.3%（范围：47.3%-82.2%）。未发现发表偏倚（ =.57）。CE-MRI 的阳性似然比为 3.1，CEM 为 3.6，而 CE-MRI 的阴性似然比（0.04）低于 CEM（0.12）。CE-MRI 对乳腺癌的敏感性高于 CEM（97%[95%CI：86，99]与 91%[95%CI：77，97]； <.001），但特异性较低（69%[95%CI：46，85]与 74%[95%CI：52，89]； =.09）。Fagan 列线图表明，两种检测方法均能排除乳腺癌的最大术前概率为 CE-MRI 为 33%，CEM 为 14%。此外，碘浓度与 CEM 的敏感性呈正相关，与特异性呈负相关（ =.04 和 <.001，分别）。结论 与对比增强乳腺摄影相比，对比增强磁共振成像具有更高的敏感性和阴性似然比，在更高的术前概率下可排除恶性肿瘤。©2022 RSNA，见本期 Mann 和 Veldhuis 的社论。
