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To investigate the inter-rater reliability and agreement of the automated breast volume scanner (ABVS) and the diagnostic accuracy for differentiating malignant and benign lesions. The overall aim was to find out if the ABVS is applicable to daily clinical practice. Qualifying studies were retrieved from Pubmed, EMBASE, Cochrane Library, Biosis Preview, CBM disc and by manual search and reference lists up to 30 September 2014. Pooled sensitivity and specificity of ABVS were calculated and summary receiver operating characteristic curves were drawn. Thirteen studies were included in the meta-analysis of diagnostic accuracy and seven studies were included in the systematic review of inter-rater reliability/agreement of ABVS. For ‘diagnostic accuracy’, the pooled values of sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio were 92 % (95 % CI 89.9–93.8), 84.9 % (82.4–87.0), 6.172 (4.364–8.730), 0.101 (0.075–0.136), and 72.226 (39.637–131.61), respectively. For the studies of inter-rater reliability/agreement, the quality was heterogeneous and no evidenced result can be pooled. Sensitivity and specificity of ABVS for differentiating malignant and benign breast lesions were high. More sound studies focusing on inter-rater reliability/agreement of ABVS, which deeply affect the clinical utilization and generalization of ABVS, are urgently needed. • ABVS has high sensitivity and specificity in differentiating malignant and benign breast lesions. • The quality of published inter-rater reliability studies is heterogeneous. • Empirical evidence concerning the inter-rater reliability/agreement for the ABVS is rare. • Comparison studies on ABVS and other medical imaging examinations are warranted.