Contrast-Enhanced Mammography in the Work-up of Asymmetries: A Systematic Review and Meta-analysis
Abstract
RATIONALE AND OBJECTIVES
Contrast-enhanced mammography (CEM) is increasingly used to evaluate mammographic or digital breast tomosynthesis (DBT) detected asymmetries. We performed a systematic review and meta-analysis to estimate the diagnostic performance of CEM in this setting, focusing on the negative predictive value (NPV) of non-enhancing asymmetries.
MATERIALS AND METHODS
MEDLINE and Embase were searched through October 2025 for studies reporting outcomes of CEM in mammographic/DBT-detected asymmetries with histopathology and/or imaging follow-up. Study selection and data extraction were performed by two readers. Random-effects models with Hartung-Knapp adjustment were used for pooled estimates. Exact aggregated binomial confidence intervals were calculated for zero-event analyses. Risk of bias was assessed using QUADAS-2.
RESULTS
Four retrospective single-center studies met inclusion criteria. Across 147 non-enhancing asymmetries (NEAs) with definitive outcomes, no false-negative cancers were observed. Study-level NPVs were 100%. Random-effects pooling yielded an NPV of 0.98 (95% CI, 0.85-0.997; I² = 0%). Exact aggregated binomial analysis demonstrated an NPV of 100% with a conservative 95% lower bound of 97.5%. Enhancing asymmetries, particularly mass-type and suspicious non-mass enhancement, were strongly associated with malignancy. Accuracy and positive predictive value (PPV) varied by study setting and prevalence.
CONCLUSION
In appropriately selected…
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Evidence Hub reads this as a meta-analysis. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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