Diagnostic accuracy of contrast-enhanced spectral mammography for breast lesions: A systematic review and meta-analysis.

4.7 Publication bias There was evidence of borderline significance for small study effect (p value 0.08, see Fig. 7 ). 5 Discussion Combining an iodinated contrast agent with FFDM (utilising a dual energy exposure undertaken during a single breast compression), CESM may improve diagnostic accuracy in the diagnosis and staging of primary breast cancer, particularly in women with dense breasts, due to its ability to identify breast cancer that might ordinarily be masked by the dense parenchymal background (DPB) patterns on a FFDM [ 13 , 19 , 20 , 27 , 41 , 42 ].

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