Synthetic Mammography: Review of Benefits and Drawbacks in Clinical Use

Digital breast tomosynthesis (DBT) has been widely adopted as a breast cancer screening tool, demonstrating decreased recall rates and other improved screening performance metrics when compared to digital mammography (DM) alone. Drawbacks of DBT when added to 2D DM include the increased radiation dose and longer examination time. Synthetic mammography (SM), a 2D reconstruction from the tomosynthesis slices, has been introduced to eliminate the need for a separate acquisition of 2D DM. Data show that the replacement of 2D DM by SM, when used with DBT, maintains the benefits of DBT, such as decreased recall rates, improved cancer detection rates, and similar positive predictive values. Key differences between SM and 2D DM include how the image is acquired, assessment of breast density, and visualization of mammographic findings, such as calcifications. Although SM is approved by the Food and Drug Administration and has been shown to be non-inferior when used with DBT, concerns surrounding SM include image quality and artifacts. The purpose of this review article is to review the benefits, drawbacks, and screening performance metrics of SM versus DBT.