Diagnostic accuracy of cone-beam breast computed tomography and head-to-head comparison of digital mammography, magnetic resonance imaging and cone-beam breast computed tomography for breast cancer: a systematic review and meta-analysis.

Background: Cone-beam breast computed tomography (CBBCT) is a new breast imaging technique, however, CBBCT is not yet widely used, and its future application will depend on its diagnostic potential and application value. Therefore, it is of great clinical significance to systematically review and analyze the diagnostic accuracy of CBBCT for breast cancer detection in existing studies and compare it with other traditional imaging methods for the diagnosis of breast lesions. Methods: We searched PubMed, Embase, Web of Science, and Chinese databases until August 2022 for relevant papers. Studies evaluating the diagnostic accuracy of CBBCT in women with suspected breast cancer were included. Each study's quality was evaluated using the Quality Assessment of Diagnostic Performance Studies-2 (QUADAS-2) instrument. Results: Eighteen studies with a total of 1,792 patients were included in the analysis. The overall pooled sensitivity and specificity of CBBCT in diagnosing breast cancer were 0.95 [95% confidence interval (CI): 0.91-0.97] and 0.72 (95% CI: 0.62-0.80), respectively. The area under the curve (AUC) for CBBCT was 0.92 (95% CI: 0.90-0.94). In a head-to-head comparison of CBBCT and digital mammography (DM), eight trials with 992 patients were included in the study, and the AUCs for CBBCT and DM were 0.94 (95% CI: 0.92-0.96) and 0.83 (95% CI: 0.80-0.83), respectively. In a head-to-head comparison of CBBCT and magnetic resonance imaging (MRI), four trials with 203 patients were included in the analysis; the AUC for CBBCT and MRI were 0.88 (95% CI: 0.85-0.91) and 0.96 (95% CI: 0.94-0.97), respectively. Conclusions: This meta-analysis of CBBCT test accuracy indicated encouraging diagnostic performance. In the summary of head-to-head comparative studies, there is a tendency for CBBCT to have greater diagnostic accuracy than DM, although its diagnostic performance is marginally inferior to that of MRI. However, the meta-analysis results were derived from studies with limited sample sizes. There is a need for more extensive research in this setting.