Abstract
Purpose: To compare the diagnostic performance of mammography (MG) alone versus MG combined with adjunctive imaging modalities, including handheld ultrasound (HHUS), automated breast ultrasound (ABUS), digital breast tomosynthesis (DBT), contrast-enhanced mammography (CEM), and magnetic resonance imaging (MRI) in women with non-dense and dense breasts. Patients and Methods: Medline, Embase, PubMed, CINAHL, Scopus, and the Web of Science databases were searched up to October 2019. Quality assessment was performed using QUADAS-2. RevMan 5.3 was used to conduct a meta-analysis of the studies. Results: In dense breasts, adding adjunctive modalities significantly increased cancer detection rates (CDRs): HHUS (relative risk [RR]=1.49; 95% confidence interval [CI], 1.19-1.86; P=.0005); ABUS (RR=1.44; 95% CI, 1.16-1.78; P=.0008); DBT (RR=1.38; 95% CI, 1.14-1.67; P=.001); CEM (RR=1.37; 95% CI, 1.12-1.69; P=.003); and MRI (RR=2.16; 95% CI, 1.81-2.58; P<.00001). The recall rate was significantly increased by HHUS (RR=2.03; 95% CI, 1.89-2.17; P<.00001), ABUS (RR=1.90; 95% CI, 1.81-1.99; P<.00001), and MRI (RR=2.71; 95% CI, 1.73-4.25; P<.0001), but not by DBT (RR=1.14; 95% CI, 0.95-1.36; P=.15). In non-dense breasts, HHUS and MRI showed significant increases in CDRs but not DBT: HHUS (RR=1.14; 95% CI, 1.01-1.29; P=.04); MRI (RR=1.78; 95% CI, 1.14-2.77; P=.01); and DBT (RR=1.09; 95% CI, 1.13-1.75; P=.08). The recall rate was also significantly increased by HHUS (RR=1.43; 95% CI, 1.28-1.59; P<.00001) and MRI (RR=3.01; 95% CI, 1.68-5.39; P=.0002), whereas DBT showed a non-significant reduction (RR=0.83; 95% CI, 0.65-1.05; P=.12). Conclusion: Adding adjunctive modalities to MG increases CDRs in women with dense and non-dense breasts. Ultrasound and MRI increase recall rates across all breast densities; however, MRI results in higher values for both CDRs and recall rates. Crown Copyright (C) 2021 Published by Elsevier Inc. All rights reserved.