title: Diagnostic performance of contrast-enhanced spectral mammography: Systematic review and meta-analysis.
abstract: OBJECTIVE
  To estimate sensitivity and specificity of CESM for breast cancer diagnosis.
  
  
  METHODS
  Systematic review and meta-analysis of the accuracy of CESM in finding breast cancer in highly selected women. We estimated summary receiver operating characteristic curves, sensitivity and specificity according to quality criteria with QUADAS-2.
  
  
  RESULTS
  Six hundred four studies were retrieved, 8 of these reporting on 920 patients with 994 lesions, were eligible for inclusion. Estimated sensitivity from all studies was: 0.98 (95% CI: 0.96-1.00). Specificity was estimated from six studies reporting raw data: 0.58 (95% CI: 0.38-0.77). The majority of studies were scored as at high risk of bias due to the very selected populations.
  
  
  CONCLUSIONS
  CESM has a high sensitivity but very low specificity. The source studies were based on highly selected case series and prone to selection bias. High-quality studies are required to assess the accuracy of CESM in unselected cases.
authors.affiliation: Institute of Anatomy, Department of Experimental Medicine, University of Genoa, Via L.B. Alberti, 16132 Genoa, Italy. Electronic address: alberto.tagliafico@unige.it.
authors.forename: Alberto Stefano
authors.initials: AS
authors.lastname: Tagliafico
authors.affiliation: Radiology Department, Department of Health Sciences, University of Genoa, Via Pastore, 16132 Genoa, Italy.
authors.forename: Bianca
authors.initials: B
authors.lastname: Bignotti
authors.affiliation: School of Medicine, University of Genoa, Via Pastore, 16132 Genoa, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Rossi
authors.affiliation: Institute of Statistics, Department of Health Sciences, University of Genoa, Via Pastore, 16132 Genoa, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Signori
authors.affiliation: Institute of Statistics, Department of Health Sciences, University of Genoa, Via Pastore, 16132 Genoa, Italy.
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Sormani
authors.affiliation: Institute of Anatomy, Department of Experimental Medicine, University of Genoa, Via L.B. Alberti, 16132 Genoa, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Valdora
authors.affiliation: Radiology Department, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Largo Rosanna Benzi 10, 16138 Genoa, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Calabrese
authors.affiliation: School of Public Health, Sydney Medical School, University of Sydney, 2006, Australia.
authors.forename: Nehmat
authors.initials: N
authors.lastname: Houssami
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D003287:Contrast Media; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D012680:Sensitivity and Specificity; D047368:Tumor Burden
chemical_list: D003287:Contrast Media
keywords: Accuracy; Contrast-enhanced spectral mammography; Meta-analysis; Sensitivity; Specificity; Systematic review