European Radiology

, Volume 27, Issue 12, pp 5185–5195 | Cite as

The role of cone-beam breast-CT for breast cancer detection relative to breast density

  • Susanne Wienbeck
  • Johannes Uhlig
  • Susanne Luftner-Nagel
  • Antonia Zapf
  • Alexey Surov
  • Eva von Fintel
  • Vera Stahnke
  • Joachim Lotz
  • Uwe Fischer



To evaluate the impact of breast density on the diagnostic accuracy of non-contrast cone-beam breast computed tomography (CBBCT) in comparison to mammography for the detection of breast masses.


A retrospective study was conducted from August 2015 to July 2016. Fifty-nine patients (65 breasts, 112 lesions) with BI-RADS, 5th edition 4 or 5 assessment in mammography and/or ultrasound of the breast received an additional non-contrast CBBCT. Independent double blind reading by two radiologists was performed for mammography and CBBCT imaging. Sensitivity, specificity and AUC were compared between the modalities.


Breast lesions were histologically examined in 85 of 112 lesions (76%). The overall sensitivity for CBBCT (reader 1: 91%, reader 2: 88%) was higher than in mammography (both: 68%, p<0.001), and also for the high-density group (p<0.05). The specificity and AUC was higher for mammography in comparison to CBBCT (p<0.05 and p<0.001). The interobserver agreement (ICC) between the readers was 90% (95% CI: 86-93%) for mammography and 87% (95% CI: 82-91%) for CBBCT.


Compared with two-view mammography, non-contrast CBBCT has higher sensitivity, lower specificity, and lower AUC for breast mass detection in both high and low density breasts.

Key Points

Overall sensitivity for non-contrast CBBCT ranged between 88%-91%.

Sensitivity was higher for CBBCT than mammography in both density types (p<0.001).

Specificity was higher for mammography than CBBCT in both density types (p<0.05).

AUC was larger for mammography than CBBCT in both density types (p<0.001).


Breast Cone-beam breast-CT Ultrasound Mammography Breast density 



Cone-beam breast computed tomography




Magnet resonance imaging


Hounsfield units


Breast Imaging Reporting and Data System


American College of Radiology




Region of interest



The authors acknowledge the team of the Diagnostic Breast Center Göttingen, Germany for their continuous and excellent support.

The preliminary data from this study from Wienbeck S. et al. have been presented at the European Congress of Radiology in Vienna, on 2 March 2016 (Scientific Session SS 302, B-0218).

Compliance with ethical standards


The scientific guarantor of this publication is Prof. Dr. Joachim Lotz, MD.

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.


The authors state that this work has not received any funding.

Statistics and biometry

PD Dr. Antonia Zapf, PhD and Dr. Johannes Uhlig, MD MPH kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was obtained from all patients in this study.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• observational study

• performed at one institution


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Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  • Susanne Wienbeck
    • 1
  • Johannes Uhlig
    • 1
  • Susanne Luftner-Nagel
    • 2
  • Antonia Zapf
    • 3
  • Alexey Surov
    • 4
  • Eva von Fintel
    • 1
  • Vera Stahnke
    • 1
  • Joachim Lotz
    • 1
  • Uwe Fischer
    • 2
  1. 1.Institute for Diagnostic and Interventional RadiologyUniversity Medical Center GöttingenGöttingenGermany
  2. 2.Diagnostic Breast Center GöttingenGöttingenGermany
  3. 3.Department of Medical StatisticsUniversity Medical Center GöttingenGöttingenGermany
  4. 4.Department of Diagnostic and Interventional RadiologyUniversity of LeipzigLeipzigGermany

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