A meta-analysis of contrast-enhanced spectral mammography versus MRI in the diagnosis of breast cancer

Background To identify the performance of contrast-enhanced spectral mammography (CESM) and magnetic resonance imaging (MRI) for breast cancer diagnosis by pooling the open published data. Methods A systematic review of studies relevant to CESM and MRI in the diagnosis of breast cancer were screened in the electronic databases of Pubmed, EMBASE, the Cochrane Library, Web of Science, Google scholar and CNKI. The methodical quality of the included publications was evaluated by the quality assessment of diagnostic accuracy studies-2 (QUADAS-2). The diagnostic sensitivity, specificity and area under the ROC curve (AUC) were pooled and the true positive (TP), false positive (FP), false negative (FN) and true negative (TN) of the original studies were calculated. Results A total of 13 diagnostic publications were identified and included in the meta-analysis. Of those included, five were retrospective studies and the remaining eight were prospective work. The combined data indicating the pooled sensitivity and specificity of CESM and MRI were 0.97 (95% CI: 0.95-0.98), 0.66 (95% CI: 0.59-0.71), 0.97 (95% CI: 0.95-0.98),and 0.52 (95% CI: 0.46-0.58), respectively. The pooled +LR and -LR for CESM were 2.70 (95% CI: 1.57-4.65), 0.06 (95% CI: 0.04-0.09), and 2.01 (95% CI: 1.78-2.26), 0.08 (95% CI: 0.05-0.11) for MRI, respectively. For the diagnostic odds ratio (DOR), the pooled results of CESM and MRI were 60.15 (95% CI: 24.72-146.37) and 31.34 (95% CI: 19.61-50.08), respectively. The AUC of the symmetric receiver operating characteristic curve (SROC) was 0.9794 and 0.9157 for CESM and MRI, respectively, calculated using the Moses model in the diagnosis of breast cancer. Conclusions Both CESM and MRI are effective methods for the detection of breast cancer with high diagnostic sensitivity. The diagnostic performance of CESM appears to be more effective than MRI.