A body of research has already established 2D synthetic mammography (SM) as no less useful than full-field digital mammography (FFDM) for finding various types of suspicious lesions at screening.
A new study takes this one step further, showing the synthetic option—which requires less radiation—is full-field’s match even for finding and assessing microcalcifications.
The study, conducted at Weill Cornell Medicine in New York, is running ahead of print in the American Journal of Roentgenology.
Lead author Katerina Dodelzon, MD, and colleagues had three breast-imaging specialists read screening mammograms acquired with digital breast tomosynthesis and both FFDM and SM.
The studied images included exams from 70 patients who were called back for further assessment of microcalcifications. Half this cohort had malignancies, the other half benign lesions, and the readers further interpreted 90 negative exams.
To find the readers’ preferences between SM and FFDM, the research team had them record BI-RADS assessments and probabilities of malignancy and, finally, record their subjective evaluations of overall diagnostic confidence and of how clearly the microcalcifications appeared in SM vs. FFDM.
Dodelzon and colleagues report that SM’s performance was slightly better that of FFDM, with the former returning an AUC of 90% and the latter 87%.
Meanwhile, though, reader preferences were mixed—especially when it came to confidence for making BI-RADS assessments.
Here the authors comment that, because SM is likely to replace FFDM in clinical practice thanks to its comparable performance and radiation reduction, “it is reassuring that … radiologists’ subjective perception of microcalcifications is improved with SM versus FFDM, with no difference noted in subjective diagnostic confidence between the two modalities and final cancer outcome.”
However, they add, given the reader variability they observed in diagnostic confidence regarding BI-RADS assessment, practices planning on replacing FFDM with SM “ought to be aware of the potential tentativeness associated with BI-RADS assessment on SM and provide their radiologists with objective data on the noninferior, and potentially improved, performance of SM in detecting microcalcifications compared with FFDM.”
The authors call for additional prospective studies with larger numbers of readers and, potentially, stratifications of mammographic findings according to the size and shape of microcalcifications.
They also hope for more evaluations of the reader experience. Taken together, they believe, these additional aspects “are ultimately warranted to exclude small differences in the performance of SM.”
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.