CONTRAST-enhanced mammography confirmed good accuracy for assessing breast most cancers response after neoadjuvant remedy in pooled knowledge.
A scientific evaluate and meta-analysis of 15 research involving 793 sufferers discovered that contrast-enhanced mammography might supply a clinically helpful choice for evaluating pathological full response after neoadjuvant remedy, with diagnostic efficiency described as similar to MRI.
Neoadjuvant remedy is more and more utilized in breast most cancers administration to downstage tumors, help breast-conserving surgical procedure, and supply an early measure of remedy response. Whereas MRI stays the reference normal for response evaluation, value, entry, acquisition time, and affected person tolerance can restrict its use. Distinction-enhanced mammography combines mammographic anatomical element with contrast-based practical imaging, enabling visualization of tumor enhancement in a single examination.
Diagnostic Accuracy Helps Medical Potential
Utilizing surgical histopathology because the reference normal, pooled evaluation confirmed a diagnostic odds ratio of 9.30, with substantial heterogeneity throughout research. Sensitivity was 74%, whereas specificity was 82%, indicating that contrast-enhanced mammography had moderate-to-high efficiency for figuring out pathological full response after neoadjuvant remedy.
The abstract receiver working attribute curve confirmed an space beneath the curve of 0.83, supporting good total diagnostic accuracy. Based mostly on a reported pathological full response prevalence of 31.7%, constructive predictive worth was 66% and unfavourable predictive worth was 87%. This excessive unfavourable predictive worth means that absence of irregular enhancement on contrast-enhanced mammography might assist scale back the chance of residual illness.
Findings In contrast With MRI
The evaluation reinforces contrast-enhanced mammography as a sensible imaging strategy when MRI is unavailable, contraindicated, poorly tolerated, or much less accessible. Its potential to supply each anatomical and practical info could also be significantly priceless after neoadjuvant remedy, when clinicians want to tell apart residual illness from treatment-related adjustments.
Nevertheless, the findings additionally spotlight limits. The reasonable constructive predictive worth means contrast-enhanced mammography shouldn’t be used alone to verify pathological full response. Histopathologic evaluation stays important, significantly as a result of residual nodal illness and delicate tumor mattress adjustments will not be absolutely captured by imaging.
Heterogeneity was initially substantial, though removing of 1 examine elevated the diagnostic odds ratio to 10.28 and lowered heterogeneity to 19.4%. Variations in tumor subtype distribution, neoadjuvant remedy regimens, imaging protocols, and pathological full response definitions might have influenced pooled estimates.
Additional potential, multicenter research are wanted to standardize acquisition protocols, interpretation standards, and histopathologic definitions. For now, contrast-enhanced mammography seems to be a promising, accessible device for post-neoadjuvant remedy breast most cancers response evaluation, significantly as a part of a multimodal technique relatively than a standalone substitute for pathology.
Reference
Galati F et al. Diagnostic accuracy of contrast-enhanced mammography in evaluating breast most cancers response to neoadjuvant remedy: a scientific evaluate and meta-analysis. Radiol Med. 2026. doi:10.1007/s11547-026-02215-y.
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