Mammography remains the mainstay of screening for primary breast cancer, however, some limitations persists in women with dense breast, in its inability to differentiate a benign from a malignant lesion, and in its heavy reliance on the radiologists' skill. Breast specific gamma imaging, which evaluates the functional images rather than anatomic images seen in mammography, addresses these limitations and can be a potential adjunct in screening for breast cancer. This meta-analysis aims to determine the diagnostic accuracy of breast specific gamma imaging for diagnosing breast cancer in women who are high risk. We searched PUBMED (1999-2009) and Google Scholar (1999-2009) for diagnostic accuracy studies that compared breast specific gamma imaging with histopathologic diagnosis of breast cancer in high risk women. Citation searches and screening of references of included studies were conducted. Two authors searched citations that correlated with the criteria using a data collection form. The methodological quality was then assessed by three authors using the QUADAS method. HSROC meta-analytical tool was used to estimate summary ROC curves. Four studies with 360 participants and 411 lesions were included. Breast specific gamma imaging has a high sensitivity (84%-97%) and specificity (60%-86%). SROC shows the included studies have high overall accuracy. Breast specific gamma imaging has high diagnostic accuracy in detecting breast cancer in women at high risk.