Head-to-head comparison of cone-beam breast computed tomography and mammography in the diagnosis of primary breast cancer: A systematic review and meta-analysis.

• Head-to-head comparison reveals superior diagnostic performance of cone-beam breast computed tomography over mammography for primary breast cancer. • Z-test indicates significantly higher sensitivity of cone-beam breast computed tomography compared to mammography. • Cone-beam breast computed tomography and mammography have similar specificity in diagnosing primary breast cancer. To compare the diagnostic performance of cone-beam breast computed tomography (CBBCT) and mammography (MG) in primary breast cancer. PubMed, Embase, Web of Science, China National Knowledge Infrastructure, WanFang DATA, and China Science and Technology Journal databases were searched comprehensively from inception to March 2023. Sensitivity and specificity were calculated using bivariate random-effects models, and a summary receiver operating characteristic (SROC) curve was constructed. Bivariate I2 statistics and meta-regression analyses were also performed. The differences in diagnostic performance between CBBCT and MG were analysed using Z-test statistics. Clinical utility was explored using Fagan's nomogram, and quality assessment was conducted utilising the Quality Assessment of Diagnostic Accuracy Studies-2 checklist. The summary sensitivity and specificity for CBBCT in diagnosing primary breast cancer were 0.92 (95 % CI: 0.87–0.94) and 0.79 (95 % CI: 0.71–0.85), respectively, and the area under the curve (AUC) of the SROC was 0.93 (95 % CI: 0.90–0.95). For MG, the summary sensitivity and specificity were 0.77 (95 % CI: 0.69–0.83) and 0.75 (95 % CI: 0.66–0.82), respectively, with an AUC of 0.83 (95 % CI: 0.80–0.86). The Z-test revealed that the summary sensitivity of CBBCT was significantly higher than that of MG (P < 0.001). Additionally, the summary AUC of CBBCT was significantly higher than that of MG (P < 0.001). The diagnostic performance of CBBCT for primary breast cancer was better than that of MG. However, the results of both the CBBCT and MG are based on studies with small sample sizes. Further studies with larger sample sizes and more comprehensive designs are required to address this issue. [ABSTRACT FROM AUTHOR]