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Synthetic 2-Dimensional Mammography Can Replace Digital Mammography as an Adjunct to Wide-Angle Digital Breast Tomosynthesis

Clauser, Paola, MD*; Baltzer, Pascal A.T., MD*; Kapetas, Panagiotis, MD*; Woitek, Ramona, MD*; Weber, Michael, PhD; Leone, Federica, MD; Bernathova, Maria, MD*; Helbich, Thomas H., MD*

doi: 10.1097/RLI.0000000000000513
Original Articles
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Objectives The aim of this study was to evaluate the detection rate and diagnostic performance of 2-dimensional synthetic mammography (SM) as an adjunct to wide-angle digital breast tomosynthesis (WA-DBT) compared with digital mammography (DM) alone or to DM in combination with WA-DBT.

Materials and Methods There were 205 women with 179 lesions included in this retrospective reader study. Patients underwent bilateral, 2-view (2v) DM and WA-DBT between March and June 2015. The standard of reference was histology and/or 1-year stability at follow-up. Four blinded readers randomly evaluated images according to the BI-RADS lexicon from 3 different protocols: 2v DM alone, 2v DM with 2v WA-DBT, and 2v SM with 2v WA-DBT. Detection rate, sensitivity, specificity, and accuracy were calculated and compared using multivariate analysis. Readers' confidence and image quality were evaluated.

Results The detection rate ranged from 68.7% to 79.9% for DM, 76.5% to 84.4% for DM with WA-DBT, and 73.2% to 84.9% for SM with WA-DBT. Sensitivity and accuracy were significantly higher when DBT was available (P < 0.001). Specificity did not differ significantly between DM only, DM with WA-DBT, or SM with WA-DBT (P ≥ 0.846). Wide-angle DBT combined readings did not differ between SM and DM in terms of sensitivity, specificity, and accuracy (P ≥ 0.341). Readers' confidence and image quality was rated good to excellent.

Conclusions Wide-angle DBT combined with DM or SM increases sensitivity and accuracy without reducing specificity compared with DM alone. Wide-angle DBT combined readings did not differ between SM and DM; therefore, SM should replace DM for combined readings with WA-DBT.

From the *Department of Biomedical Imaging and Image-Guided Therapy,

Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria; and

ASST Fatebenefratelli-Sacco, Ospedale Fatebenefrateli e Oftalmico, Milan, Italy.

Received for publication July 12, 2018; and accepted for publication, after revision, August 14, 2018.

Conflicts of interest and sources of funding: The study was sponsored by Siemens Healthcare (T.H.H.). P.C. and M.B. have received speaker honoraria from Siemens Healthcare. For the remaining authors, none were declared.

Correspondence to: Thomas H. Helbich, MD, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, General Hospital Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. E-mail: thomas.helbich@meduniwien.ac.at.

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