An Updated Systematic Review and Meta-Analysis of Diagnostic Accuracy of Dynamic Contrast Enhancement and Diffusion-Weighted MRI in Differentiating Benign and Malignant Non-Mass Enhancement Lesions.

: This study systematically evaluates the diagnostic accuracy of dynamic contrast-enhanced MRI (DCE-MRI), diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) values. : The literature search started and ended on 10 June 2024. We searched MEDLINE, Cochrane Library, Pubmed, Science Direct, and Google Scholar. Our research question could be formulated as "In women with NME detected by MRI, how accurate are DCE and DWI in ruling in and ruling out malignancy when the diagnosis is compared to histopathology analysis with or without a clinical follow-up?". The meta-analysis was conducted using the STATA 17 software with the "midas" commands. The study protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO) database. : Fifty-four studies involving 6121 NME lesions were analyzed. The combined use of DCE-MRI and DWI demonstrated the highest diagnostic accuracy (AUC: 0.91; 95% CI: 0.88-0.93), followed by DWI alone (AUC: 0.85; 95% CI: 0.81-0.87) and ADC (AUC: 0.77; 95% CI: 0.74-0.81). DCE-MRI alone showed the lowest performance (AUC: 0.68; 95% CI: 0.64-0.72). Significant heterogeneity was observed across all modalities, with I values exceeding 95% in several analyses. The likelihood ratio scattergram indicated that no modality reliably confirmed or excluded malignancy. : While the combination of DCE-MRI and DWI achieves the highest diagnostic accuracy, no modality can reliably differentiate benign from malignant NME lesions. Standardized imaging protocols and refined diagnostic descriptors are needed for clinical improvement.