Diagnostic accuracy of cone-beam breast computed tomography: a systematic review and diagnostic meta-analysis
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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.
• 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.
KeywordsBreast 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.
Written informed consent was not required for this study because it is a meta-analysis.
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.
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