Breast Cancer

, Volume 27, Issue 1, pp 47–53 | Cite as

Comparison of the diagnostic performance of synthesized two-dimensional mammography and full-field digital mammography alone or in combination with digital breast tomosynthesis

  • Chao You
  • Yunyan Zhang
  • Yajia Gu
  • Qin Xiao
  • Guangyu Liu
  • Xigang Shen
  • Wentao Yang
  • Weijun PengEmail author
Original Article



To investigate whether digital breast tomosynthesis (DBT) and subsequently generated synthesized mammography (SM) images show a better performance than full-field digital mammography (FFDM) images for diagnosing malignant breast lesions. In addition, the radiation doses for SM using different procedures were compared.

Materials and methods

This prospective study enrolled 212 women (age ≥ 25 years) with clinically suspicious breast lesions. All participants underwent FFDM and DBT with the same breast compression. Finally, 222 lesions were confirmed by pathological analysis. The mammogram results were evaluated according to the BI-RADS criteria and compared with the pathological results. The diagnostic performances, morphological features and average glandular doses (AGDs) were compared.


In total, 141 malignant lesions and 81 benign lesions were confirmed by pathological analysis. The overall AGD showed no significant difference between FFDM and DBT. Compared with 2D imaging, the AUC values of FFDM plus DBT and SM plus DBT were both significantly different overall (P = 0.0002) and remained significantly different in dense breasts (P < 0.0001). In terms of morphologic characteristics, lesions showed similar morphology between FFDM and SM, while the lesion characteristics were discordant from 2D imaging to DBT in 33 lesions in dense breasts.


Compared to FFDM, 2D SM images generated from DBT had significantly improved diagnostic efficacy for detecting malignant breast lesions without increasing radiation doses. This new procedure is useful for characterizing breast lesions, particularly in dense breasts.


Digital breast tomosynthesis Synthesized mammography Diagnostic performance Digital mammography Breast lesion 



We thank all the patients of this study for their participation. We greatly appreciate Li Liu, Xiaojing Zheng, Jian Wu, Danting Hu and Yujiao Jin at Department of Radiology for their excellent assistance.


Weijun Peng received funding from the National Natural Science Foundation of China (Grant number: 61731008). Yajia Gu received funding from National Key Research and Development Program of China (Grant number: 2016YFC1303003) and Cancer Research Program of National Cancer Center (Grant number: NCC2017A03). Chao You received funding from Shanghai Municipal Health Planning Commission Youth Project (Grant number: 20184Y0010).

Compliance with ethical standards

Conflict of interest

All the authors declare that have no conflict of interest.


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Copyright information

© The Japanese Breast Cancer Society 2019

Authors and Affiliations

  1. 1.Department of RadiologyFudan University Cancer CenterShanghaiPeople’s Republic of China
  2. 2.Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiPeople’s Republic of China
  3. 3.Department of RadiologyShanghai Proton and Heavy Ion CenterShanghaiPeople’s Republic of China
  4. 4.Key Laboratory of Breast Cancer in Shanghai, Department of Breast SurgeryFudan University Shanghai Cancer CenterShanghaiPeople’s Republic of China
  5. 5.Department of PathologyFudan University Shanghai Cancer CenterShanghaiPeople’s Republic of China

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