Comparing synthetic mammograms based on wide-angle digital breast tomosynthesis with digital mammograms.

Purpose: We aim to investigate the characteristics and evaluate the performance of synthetic mammograms (SMs) based on wide-angle digital breast tomosynthesis (DBT) compared with digital mammography (DM). Approach: Fifty cases with both synthetic and digital mammograms were selected from the Malmö Breast Tomosynthesis Screening Trial. They were categorized into five groups consisting of normal cases and recalled cases with false-positive and true-positive findings from DM and DBT only. The DBT system used was a wide-angle (WA) system from Siemens, and the SM images were reconstructed from the DBT images. Visual grading, detection, and recall were evaluated by experienced breast radiologists in both SM and DM images. Results: Some image quality criteria of the SM images were rated as qualitatively inferior to DM images. However, reader-averaged diagnostic accuracy (0.57 versus 0.55), sensitivity (0.46 versus 0.50), and specificity (0.64 versus 0.58) were not significantly different between SM and DM, respectively. Conclusions: Synthetic mammography plays a promising role to complement or even replace DM. The study could not find any indications of substantial differences in the sensitivity or specificity of SM for WA DBT systems compared with DM. However, certain image quality criteria of SM fall slightly short compared with DM images. Next-generation DBT systems could address such limitations through improved reconstruction algorithms and system design, and their performance should be the focus of future research studies.