Clinical implementation of synthesized mammography with digital breast tomosynthesis in a routine clinical practice

Breast Cancer Res Treat. 2017 Nov;166(2):501-509. doi: 10.1007/s10549-017-4431-1. Epub 2017 Aug 5.


Background: Most published studies evaluating digital breast tomosynthesis (DBT) included a separate 2-dimensional full-field digital mammogram (FFDM) for DBT screening protocols, increasing radiation from screening mammography. Synthesized mammography (SM) creates a 2-dimensional image from the DBT source data, and if used in place of FFDM, it reduces radiation of DBT screening. This study evaluated the implementation of SM + DBT in routine screening practice in terms of recall rates, cancer detection rates (CDR), % of minimal cancers, % of node-positive cancers, and positive predictive values (PPV).

Materials and methods: A multivariate retrospective institutional analysis was performed on 31,979 women who obtained screening mammography (10/2013-12/2015) with cohorts divided by modality (SM + DBT, FFDM + DBT, and FFDM). We adjusted for comparison mammograms, age, breast density, and the interpreting radiologist. Recall type was analyzed for differences (focal asymmetry, asymmetry, masses, calcifications, architectural distortion).

Results: SM + DBT significantly decreased the recall rate compared to FFDM (5.52 vs. 7.83%, p < 0.001) with no differences in overall CDR (p = 0.66), invasive and/or in situ CDR, or percentages of minimal and node-negative cancers. PPV1 significantly increased with SM + DBT relative to FFDM (9.1 vs. 6.2%, p = 0.02). SM + DBT did not differ significantly in recall rate or overall CDR compared to FFDM + DBT. There were statistically significant differences in certain findings recalled by screening modality (e.g., focal asymmetries).

Conclusions: SM + DBT reduces false positives compared to FFDM, while maintaining the CDR and other desirable audit outcome data. SM + DBT is more accurate than FFDM alone, and is a desirable alternative to FFDM + DBT, given the added benefit of radiation reduction.

Keywords: Breast cancer; Cancer detection; Digital breast tomosynthesis; Mammography; Screening; Tomosynthesis.

MeSH terms

  • Breast Density
  • Breast Neoplasms / diagnostic imaging*
  • Early Detection of Cancer
  • Female
  • Humans
  • Mammography / methods*
  • Mass Screening
  • Radiographic Image Enhancement / methods*
  • Retrospective Studies
  • Sensitivity and Specificity