European Radiology

, Volume 29, Issue 3, pp 1194–1202 | Cite as

Diagnostic accuracy of cone-beam breast computed tomography: a systematic review and diagnostic meta-analysis

  • Johannes UhligEmail author
  • Annemarie Uhlig
  • Lorenz Biggemann
  • Uwe Fischer
  • Joachim Lotz
  • Susanne Wienbeck



To review the published evidence on cone-beam breast computed tomography (CBBCT) and summarize its diagnostic accuracy for breast lesion assessment.

Materials and Methods

A systematic literature search was conducted using the EMBASE, MEDLINE and CENTRAL libraries. Studies were included if reporting sensitivity and specificity for discrimination of benign and malignant breast lesions via breast CT. Sensitivity and specificity were jointly modeled using a bivariate approach calculating summary areas under the receiver-operating characteristics curve (AUC). All analyses were separately performed for non-contrast and contrast-enhanced CBBCT (NC-CBBCT, CE-CBBCT).


A total of 362 studies were screened, of which 6 with 559 patients were included. All studies were conducted between 2015 and 2018 and evaluated female participants. Four of six studies included dense and very dense breasts with a high proportion of microcalcifications. For NC-CBBCT, pooled sensitivity was 0.789 (95% CI: 0.66–0.89) and pooled specificity was 0.697 (95% CI: 0.471–0.851), both showing considerable significant between-study heterogeneity (I2 = 89.4%, I2 = 94.7%, both p < 0.001). Partial AUC for NC-CBBCT was 0.817. For CE-CBBCT, pooled sensitivity was 0.899 (95% CI: 0.785–0.956) and pooled specificity was 0.788 (95% CI: 0.709–0.85), both exhibiting non-significant moderate between-study heterogeneity (I2 = 57.3%, p = 0.0527; I2 = 53.1%, p = 0.0738). Partial AUC for CE-CBBCT was 0.869.


The evidence available for CBBCT tends to show superior diagnostic performance for CE-CBBCT over NC-CBBCT regarding sensitivity, specificity and partial AUC. Diagnostic accuracy of CE-CBBCT was numerically comparable to that of breast MRI with meta-analyses reporting sensitivity of 0.9 and specificity of 0.72.

Key Points

• CE-CBBCT rather than NC-CBBCT should be used for assessment of breast lesions for its higher diagnostic accuracy.

• CE-CBBCT diagnostic performance was comparable to published results on breast MRI, thus qualifying CE-CBBCT as a potential imaging alternative for patients with MRI contraindications.


Breast Cone-beam computed tomography Contrast media Radiation dosage Meta-analysis 



American College of Radiology


Area under the curve


Cone-beam breast CT


Contrast-enhanced cone-beam breast CT




Magnetic resonance imaging


Non-contrast cone-beam breast CT





The authors did not receive funding for work related to this manuscript.

Compliance with ethical standards


The scientific guarantor of this publication is Susanne Wienbeck.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Two authors have significant statistical expertise.

Informed consent

Written informed consent was not required for this study because it is a meta-analysis.

Ethical approval

This study was performed in accordance with the Declaration of Helsinki. Ethical committee approval was not necessary because of the meta-analysis design.

Study subjects or cohorts overlap

Parts of the study population have been previously reported as detailed in the Materials and Methods section as well as the references.


• observational

Supplementary material

330_2018_5711_MOESM1_ESM.docx (14 kb)
ESM 1 (DOCX 14 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of Diagnostic and Interventional RadiologyUniversity Medical Center GoettingenGoettingenGermany
  2. 2.Section of Interventional Radiology, Department of Radiology and Biomedical ImagingYale School of MedicineNew HavenUSA
  3. 3.Department of UrologyUniversity Medical Center GoettingenGoettingenGermany
  4. 4.Diagnostic Breast Imaging CenterGoettingenGermany
  5. 5.German Centre for Cardiovascular Research, Partnersite GoettingenGoettingenGermany

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