Contrast MRI or Contrast mammography: which is better for detecting breast cancer? A research paper sheds light

Contrast-enhanced mammography (CEM) and the Contrast-enhanced MRI (CE-MRI) performed similarly in detecting breast cancer, according to a recent study published in Radiology, but CE-MRI demonstrated superior sensitivity.

In breast imaging, CEM is a more accessible substitute to CE-MRI, but there is no summary comparison of studies published. Pascal A. T. Baltzer of the Medical University of Vienna and the General Hospital in Vienna- Austria, and colleagues compared the specificity, sensitivity, and negative predictive value of CE-MRI and CEM in detecting breast cancer in order to fill this knowledge gap.

Two readers extracted data from studies comparing the diagnostic performance of CE-MRI and CEM in the detection of breast cancer. The studies taken were published before April 2021 . Bivariate random effects models had been used to calculate sensitivity, specificity, negative predictive value, and negative and positive likelihood ratios.

The max pretest probability during which posttest probabilities of a negative CE-MRI or CEM examination were in line with the two percent malignancy rate benchmark for downgrading BI-RADS category 4 to BI-RADS category 3 results was determined using a Fagan nomogram.

The following are the research results:

In seven studies, there were 1137 lesions (483 benign, 654 malignant,) with a cancer prevalence of 65.3 percent (range: 47.3 percent –82.2 percent). No evidence of publication bias was found (P =.57).

Despite having 3.1 positive likelihood ratios, CE-MRI had a lower negative likelihood ratio (0.04) than CEM (0.12).

CE-MRI had a lower specificity (69 percent vs 74 percent )but higher sensitivity for breast cancer than CEM (97% vs 91%, respectively).

According to a Fagan nomogram, the maximum pretest probability for both tests ruling out breast cancer was14% for CEM and 33% for CE-MRI.

CEM sensitivity and specificity were found to be positively and negatively related to iodine concentration.

Conclusion:

"Contrast-enhanced MRI had enhanced sensitivity and negative likelihood ratios, as well as higher pretest probabilities for ruling out malignancy when compared to contrast-enhanced mammography," the researchers write.