# Diagnostic performance of contrast‐enhanced mammography for suspicious findings in dense breasts: A systematic review and meta‐analysis

## TL;DR

Contrast-enhanced mammography shows high accuracy in detecting suspicious lesions in dense breasts, with enhanced and irregular-margin lesions often being malignant.

## Contribution

This study provides a meta-analysis of CEM's diagnostic performance for dense breasts, revealing strong sensitivity and malignancy correlations.

## Key findings

- CEM has a summary sensitivity of 0.95 and specificity of 0.81 for detecting suspicious lesions in dense breasts.
- Enhanced lesions and irregular margins are strongly associated with malignancy.
- The malignancy odds ratio for enhanced lesions is 28.11, and for circumscribed margins is 0.17.

## Abstract

Contrast‐enhanced spectral imaging (CEM) is a new mammography technique, but its diagnostic value in dense breasts is still inconclusive. We did a systematic review and meta‐analysis of studies evaluating the diagnostic performance of CEM for suspicious findings in dense breasts.

The PubMed, Embase, and Cochrane Library databases were searched systematically until August 6, 2023. Prospective and retrospective studies were included to evaluate the diagnostic performance of CEM for suspicious findings in dense breasts. The QUADAS‐2 tool was used to evaluate the quality and risk of bias of the included studies. STATA V.16.0 and Review Manager V.5.3 were used to meta‐analyze the included studies.

A total of 10 studies (827 patients, 958 lesions) were included. These 10 studies reported the diagnostic performance of CEM for the workup of suspicious lesions in patients with dense breasts. The summary sensitivity and summary specificity were 0.95 (95% CI, 0.92–0.97) and 0.81 (95% CI, 0.70–0.89), respectively. Enhanced lesions, circumscribed margins, and malignancy were statistically correlated. The relative malignancy OR value of the enhanced lesions was 28.11 (95% CI, 6.84–115.48). The relative malignancy OR value of circumscribed margins was 0.17 (95% CI, 0.07–0.45).

CEM has high diagnostic performance in the workup of suspicious findings in dense breasts, and when lesions are enhanced and have irregular margins, they are often malignant.