CONTRAST-ENHANCED MAMMOGRAPHY VERSUS ABBREVIATED BREAST MRI IN INTERMEDIATE-RISK BREAST CANCER SCREENING: A SYSTEMATIC REVIEW OF DIAGNOSTIC EFFICACY, ECONOMICS, AND CLINICAL UTILITY

Abstract

Background: Conventional digital mammography and digital breast tomosynthesis (DBT) demonstrate diminished sensitivity in women with dense fibroglandular tissue due to lesion masking, elevating the rate of interval cancers in intermediate-risk populations. Contrast-enhanced mammography (CEM) and abbreviated breast magnetic resonance imaging (abMRI) have emerged as premier functional modalities leveraging tumor-associated neoangiogenesis to overcome these anatomical limitations. Objective: To systematically evaluate and compare the diagnostic performance (cancer detection rate [CDR], sensitivity, specificity, recall rate), lesion characterization, health economics, throughput, and clinical implementation metrics of CEM versus abMRI in intermediate-risk breast cancer screening. Methods: Structured in accordance with PRISMA 2020 guidelines, comprehensive literature searches were conducted across PubMed/MEDLINE, EMBASE, and the Cochrane Library. Eligible clinical investigations evaluating CEM and abMRI screening or enriched cohorts were analyzed. Methodological quality and risk of bias were critically appraised using the QUADAS-2 framework. Diagnostic indices, cost-effectiveness parameters, and workflow profiles were systematically extracted and synthesized. Findings: Both modalities provide marked improvements in supplemental CDRs (ranging from 8 to 18 per 1,000 examinations) relative to anatomical mammography alone. While abMRI achieves marginally higher pooled sensitivity (90%–96% vs. 84%–92% for CEM) without ionizing radiation, CEM provides superior spatial characterization of suspicious microcalcifications, lower direct equipment and examination costs, shorter scan acquisition times, and competitive specificity (89%–95%). Background parenchymal enhancement presents diagnostic challenges for both techniques. Conclusion: Both CEM and abMRI offer compelling diagnostic benefits for intermediate-risk screening. While abMRI remains the benchmark for pure vascular sensitivity, CEM provides an operationally agile, cost-effective alternative that bridges functional vascular imaging with conventional anatomical resolution.