Authors' objectives: This report aims to identify and summarise evidence that addresses the following question: What is the clinical and cost effectiveness of cone-beam breast computed tomography compared to standard practice for diagnosis of breast cancer?

Authors' results and conclusions: Overall, the evidence suggests that cone-beam breast computed tomography (CBBCT) demonstrated higher sensitivity compared to 2D digital mammography; however, CBBCT had lower sensitivity when compared with magnetic resonance imaging (MRI). Digital breast tomosynthesis (DBT) had better specificity than CBBCT. However, there is a need for comparative studies to more accurately determine the diagnostic accuracy of CBBCT compared to DBT. Regarding patient comfort, three studies reported on patient comfort experienced during CBBCT in relation to 2D digital mammography examinations. Ratings of patient comfort tended to favour CBBCT, including both CBBCT modes (i.e., contrast-enhanced [CE]-CBBCT and non-contrast [NC]-CBBCT), compared to mammography. Although the radiation doses for both CBBCT and digital mammography varied across studies, they were generally comparable, suggesting that both breast imaging modalities result in similar levels of patient exposure. However, DBT demonstrated lower radiation doses than CBBCT. Additionally, ultrasound imaging and MRI scans do not involve ionising radiation, highlighting their advantage in minimising patient radiation exposure.

Authors' recommendations: More evidence is needed on CBBCT for breast imaging for people with suspected breast cancer.

Authors' methods: The Evidence Appraisal Report is based on a literature search (strategy available on request) for published clinical and economic evidence on the health technology of interest. It is not a full systematic review but aims to identify the best available evidence on the health technology of interest. Researchers critically evaluate and synthesise this evidence. We include the following clinical evidence in order of priority: systematic reviews; randomised trials; non-randomised trials. We only include evidence for “lower priority” evidence where outcomes are not reported by a “higher priority” source. We also search for economic evaluations or original research that can form the basis of an assessment of costs/cost comparison. We carry out various levels of economic evaluation, according to the evidence that is available to inform this.

Authors' identified further research: There was limited clinical effectiveness evidence for CBBCT for breast imaging for people with suspected breast cancer. HTW was unable to determine cost effectiveness because the effectiveness evidence was insufficient to use for a robust evaluation. Studies directly comparing CBBCT to current standard imaging modalities in Wales, particularly digital breast tomosynthesis and contrast-enhanced mammography, are needed. Data on time to diagnosis, time to treatment, resource use and health-related quality of life outcomes are also needed.

Project Status: Completed

Year Published: 2026

URL for published report: https://healthtechnology.wales/reports-guidance/cone-beam-breast-computed-tomography/

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Wales, United Kingdom

Organisation Name: Health Technology Wales

Contact Address: c/o Digital Health Care Wales, 21 Cowbridge Road East Cardiff CF11 9AD

Contact Name: Susan Myles, PhD

Contact Email: healthtechnology@wales.nhs.uk