Diagnostic accuracy of contrast-enhanced spectral mammography for breast lesions: A systematic review and meta-analysis. (October 2020)

• Record Type: Journal Article
• Authors: Suter, Matteo Basilio; Pesapane, Filippo; Agazzi, Giorgio Maria; Gagliardi, Tania; Nigro, Olga; Bozzini, Anna; Priolo, Francesca; Penco, Silvia; Cassano, Enrico; Chini, Claudio; Squizzato, Alessandro
• Is Part Of: Breast. Volume 53(2020)
• Page Start: 8
• Page End: 17
• Publication Date: 2020-10
• Subjects: Mammography -- Breast neoplasms -- Meta-analysis -- Systematic review -- Contrast enhanced spectral mammography; Breast -- Diseases -- Periodicals; Breast -- Tumors -- Periodicals; Breast -- Periodicals; Electronic journals; Periodicals; 616
• DOI: 10.1016/j.breast.2020.06.005
• Languages: English
• ISSNs: 0960-9776

Abstract

Abstract: Breast cancer diagnosis and staging is based on mammography, ultrasound, and magnetic resonance imaging (MRI). Contrast enhanced spectral mammography (CESM) has gained momentum as an innovative and clinically useful method for breast assessment. CESM is based on abnormal enhancement of neoplastic tissue compared to surrounding breast tissue. We performed a systematic review of prospective trial to evaluate its diagnostic performance, following standard PRISMA-DTA. We used a bivariate random-effects regression approach to obtain summary estimates of both sensitivity and specificity of CESM. 8 studies published between 2003 and 2019 were included in the meta-analysis for a total of 945 lesions. The summary area under the curve obtained from all the study was 89% [95% CI 86%–91%], with a sensitivity of 85% [95% CI 73%–93%], and a specificity of 77% [95% CI 60%–88%]. With a pre-test probability of malignancy of 57% a positive finding at CESM gives a post-test probability of 83% while a negative finding a post-test probability of 20%. CESM shows a suboptimal sensitivity and specificity in the diagnosis of breast cancer in a selected population, and at present time, it could be considered only as a possible alternative test for breast lesions assessment when mammography and ultrasound are not conclusive or MRI is contraindicated or not available. Highlights: CESM is based on abnormal enhancement of neoplastic tissue compared to surrounding breast tissue. The summary AUC for CESM in patients with breast cancer suspicion was 89%, with 85% sensitivity and 77% specificity. With a pre-test probability of malignancy of 57% a positive finding at CESM gives a post-test probability of 83%. With a pre-test probability of malignancy of 57% a negative finding at CESM gives a post-test probability of 20%. CESM shows a suboptimal sensitivity and specificity in the diagnosis of breast cancer in a selected population.