摘要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.