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Although magnetic resonance imaging (MRI) is the gold standard, its limitations have prompted growing interest in alternatives such as contrast-enhanced mammography (CEM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This review was conducted according to PRISMA guidelines. We evaluated CEM accuracy in predicting pathological complete response after NAT, using surgery as reference standard. A comprehensive search was conducted in PubMed\/Medline, Embase, Cochrane, and Web of Science. Two reviewers screened studies, extracted data, and evaluated risk of bias with QUADAS-2 tool. A bivariate random-effects model estimated diagnostic odds ratio (DOR), sensitivity, specificity, and likelihood ratios. Summary receiver operating characteristic (sROC) curves were generated, and heterogeneity was quantified using Higgins\u2019 I\n                      <jats:sup>2<\/jats:sup>\n                      . Publication bias was assessed via Deek\u2019s funnel plot.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fifteen studies, including 793 patients, met inclusion criteria. The pooled analysis showed a DOR of 9.30 (95% CI 4.15\u201320.83) with substantial heterogeneity (I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200972.30%). Pooled sensitivity and specificity were 74% (95% CI 66%\u201381%) and 82% (95% CI 67%\u201391%), respectively, with an sROC AUC of 0.83 (95%, CI 0.67\u20130.92). Excluding the study contributing most to heterogeneity improved the DOR to 10.28 (95% CI 6.35\u201316.65) and reduced I\n                      <jats:sup>2<\/jats:sup>\n                      to 19.4% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.242).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CEM demonstrates good diagnostic accuracy for assessing NAT response, performing comparably to MRI.<\/jats:p>\n                    <jats:p>\n                      <jats:italic>Trial registration<\/jats:italic>\n                      This systematic review is registered in PROSPERO under the registration number CRD420251003406.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11547-026-02215-y","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T11:51:10Z","timestamp":1779364270000},"page":"1168-1180","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic accuracy of contrast-enhanced mammography in evaluating breast cancer response to neoadjuvant therapy: a systematic review and meta-analysis"],"prefix":"10.1007","volume":"131","author":[{"given":"Francesca","family":"Galati","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatemeh Shakki","family":"Katouli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6626-2478","authenticated-orcid":false,"given":"Roberto","family":"Maroncelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gloria","family":"Barcaroli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Narges","family":"Azizi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Spagnoli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Fabrizi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Pediconi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"key":"2215_CR1","doi-asserted-by":"publisher","first-page":"117822342098037","DOI":"10.1177\/1178223420980377","volume":"14","author":"M Asaoka","year":"2020","unstructured":"Asaoka M et al (2020) Neoadjuvant chemotherapy for breast cancer: past, present, and future. 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