Strengths and Weaknesses of Synthetic Mammography in Screening

Synthetic mammography (SM) consists of two-dimensional images reconstructed from digital breast tomosynthesis (DBT) data. Unlike standard full-field digital mammography (FFDM), SM does not require additional radiation exposure. SM is being introduced in breast imaging centers because early clinical data demonstrate that synthetic images are comparable to FFDM in cancer detection, positive predictive values, and recall rates. SM has completely replaced FFDM in some practices. Thus, an understanding of SM and its strengths and weaknesses compared with those of FFDM is essential. The artifacts of SM include blurring subcutaneous tissue, loss of resolution in the axilla on mediolateral oblique views, pseudocalcifications, and decreased resolution near foreign bodies (eg, biopsy markers). SM's strengths include a reduced radiation dose, shorter acquisition time compared with a combined FFDM/DBT screening examination (with potentially less motion artifact), and increased conspicuity of calcifications, spiculated margins, and architectural distortion. The weaknesses of SM include the potential for false positives due to pseudocalcifications and the difficulty in assessing for motion artifact. This article reviews SM and its role in screening and presents clinical cases to highlight SM's strengths, weaknesses, and artifacts.