Abstract
OBJECTIVE: Given the improved sensitivity of magnetic resonance imaging (MRI) for detecting ductal carcinoma in situ (DCIS), the omission of routine mammography (MG) or digital breast tomosynthesis (DBT) in high-risk breast cancer screening is under consideration. We aim to conduct a systematic review and meta-analysis to compare the screening sensitivity of MRI, MG and DBT for detecting DCIS in high-risk females. METHODS: PubMed, Embase, and Web of Science were searched for studies reporting the sensitivity of detecting DCIS in high-risk females up to July 02, 2025. Study quality was assessed with quality assessment of diagnostic accuracy studies-2 (QUADAS-2). Pooled sensitivity was estimated using a random-effects model, overall and stratified by age (<40 and ≥40 years old) and BRCA status (BRCA1 and BRCA2). Meta-regression was used to compare modalities. RESULTS: Seventeen studies (18,348 participants, 211 with DCIS) were included. MRI showed significantly higher pooled sensitivity [85%, 95% confidence interval (95% CI): 74%-94%] than MG (36%, 95% CI: 23%-50%; P<0.001). No DBT data were available. Combined MRI and MG yielded the highest sensitivity (99%, 95% CI: 97%-100%), but offered no significant gain over MRI alone in females <40 years old (P=0.091) and in BRCA1 mutation carriers (P=0.143). CONCLUSIONS: MRI is more sensitive than MG for DCIS detection in high-risk females. In females <40 years old and BRCA1 mutation carriers, adding MG to MRI provides no additional diagnostic value. Considering the potential trade-offs, the routine use of MG in these subgroups should be carefully reconsidered.