Contrast-enhanced mammography shows 97% sensitivity for mammographic asymmetries in meta-analysisContrast Mammography Shows High Accuracy For Breast Cancer

European journal of radiology Published June 1, 2026 Study authors: Barra Filipe Ramos, Ohannesian Victor Arthur, Andrade Fernandes João Vitor, Han Mariana Lee, Falcão … PubMed ↗ DOI ↗ Editorial oversight: Dr. Sofia Müller, MD · Lifespan & Whole-Person Care

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Key Takeaway

Consider CEM as a high-sensitivity tool for evaluating mammographic asymmetries, potentially reducing unnecessary biopsies.

This meta-analysis evaluated the diagnostic accuracy of contrast-enhanced mammography (CEM) in women with mammographic asymmetries, a common but challenging finding on screening mammography. The analysis included 1266 women with 1328 asymmetries, using histopathology or long-term follow-up as the reference standard.

Pooled results showed a sensitivity of 97% (95% CI: 87-99) and specificity of 80% (95% CI: 65-89). The positive likelihood ratio was 6.6 and the negative likelihood ratio was 0.03, suggesting CEM is effective at both ruling in and ruling out malignancy. The area under the summary ROC curve was 0.96 (95% CI: 0.94-0.97), indicating excellent overall accuracy.

The authors note that CEM could reduce unnecessary biopsies and serve as an alternative when MRI is unavailable. However, the review did not report on limitations such as study heterogeneity or publication bias, and safety data were not provided. Clinicians should consider these findings as supportive but not definitive, given the observational nature of included studies.

A new analysis of 1,266 women with mammographic asymmetries found that contrast-enhanced mammography (CEM) is highly accurate for detecting breast cancer. The study, a meta-analysis of multiple research papers, looked at how well CEM could identify cancer in women whose standard mammograms showed an area of concern.

The results showed that CEM correctly identified cancer 97% of the time (sensitivity). It also correctly ruled out cancer 80% of the time (specificity). The overall accuracy, measured by the area under the curve, was excellent at 0.96. This means CEM is very good at distinguishing between benign and malignant findings.

Because CEM is more accessible than MRI in many settings, it could help reduce the number of unnecessary biopsies for women with suspicious mammogram results. The study did not report any safety concerns or side effects.

While these results are promising, the analysis is based on existing studies and may have limitations not fully reported. Women should discuss their individual risk and diagnostic options with their doctor.

What this means for you:

Contrast-enhanced mammography is a highly accurate tool for evaluating breast cancer in women with abnormal mammograms.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedJun 2026

PMID41861612

View Original Abstract ↓

BACKGROUND: Mammographic asymmetries present a significant diagnostic challenge, often leading to unnecessary biopsies due to the limitations of conventional imaging. Contrast-enhanced mammography (CEM) has emerged as a promising modality that combines anatomical detail with functional information on tumor vascularity. However, its specific role and accuracy in evaluating asymmetries have not been systematically synthesized. This meta-analysis aims to determine the diagnostic accuracy of CEM for classifying mammographic asymmetries and its potential to reduce unnecessary interventions. METHOD: A systematic review and meta-analysis was conducted following PRISMA-DTA guidelines. The PubMed, Embase, and Web of Science databases were searched for studies published up to April 2025 that evaluated CEM for breast asymmetries using histopathology or long-term follow-up as the reference standard. A bivariate random-effects model was employed to calculate pooled estimates of sensitivity, specificity, likelihood ratios, and the area under the summary ROC curve (AUC). RESULTS: Seven studies involving 1,266 women with 1,328 asymmetries met the inclusion criteria. The pooled analysis showed that CEM has a high sensitivity of 97% (95% CI: 87-99) and a specificity of 80% (95% CI: 65-89) for detecting malignancy in asymmetries. The combined positive and negative likelihood ratios were 6.6 and 0.03, respectively. The overall diagnostic accuracy was excellent, with an AUC of 0.96 (95% CI: 0.94-0.97). CONCLUSION: CEM demonstrates high sensitivity and excellent overall accuracy in the evaluation of mammographic asymmetries, making it a valuable tool for ruling out malignancy. Its implementation in clinical practice has the potential to reduce unnecessary biopsies and optimize diagnostic pathways, offering an accessible and effective alternative, particularly in settings where MRI is unavailable.

Contrast-enhanced mammography shows 97% sensitivity for mammographic asymmetries in meta-analysisContrast Mammography Shows High Accuracy For Breast Cancer

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