European Radiology

, Volume 29, Issue 1, pp 319–329 | Cite as

Comparison of synthetic and digital mammography with digital breast tomosynthesis or alone for the detection and classification of microcalcifications

  • Ji Soo Choi
  • Boo-Kyung HanEmail author
  • Eun Young Ko
  • Ga Ram Kim
  • Eun Sook Ko
  • Ko Woon Park



To compare the performance of synthetic mammography (SM) and digital mammography (DM) with digital breast tomosynthesis (DBT) or alone for the evaluation of microcalcifications.


This retrospective study includes 198 mammography cases, all with DM, SM, and DBT images, from January to October 2013. Three radiologists interpreted images and recorded the presence of microcalcifications and their conspicuity scores and final BI-RADS categories (1, 2, 3, 4a, 4b, 4c, 5). Readers' area under the ROC curves (AUCs) were analyzed for SM plus DBT vs. DM plus DBT and SM alone vs. DM alone using the BI-RADS categories for the overall group and dense breast subgroup.


Conspicuity scores of detected microcalcifications were neither significantly different between SM and DM with DBT nor alone (p>0.05). In predicting malignancy of detected microcalcifications, no significant difference was found between readers' AUCs for SM and DM with DBT or alone in the overall group or dense breast subgroup (p>0.05).


Diagnostic performances of SM and DM for the evaluation of microcalcifications are not significantly different, whether performed with DBT or alone.

Key Points

• In DBT-imaging, SM and DM show comparable performances when evaluating microcalcifications.

• For BI-RADS classification of microcalcifications, SM and DM show similar AUCs.

• DBT with SM may be sufficient for diagnosing microcalcifications, without DM.


Microcalcification Digital breast tomosynthesis Digital mammography Synthetic image Diagnosis 



Area under the receiver operating characteristic curve


Breast Imaging Reporting and Data System


Digital breast tomosynthesis


Digital mammography


Intraclass correlation coefficient


Synthetic mammography



The authors are grateful to Seonwoo Kim, Ph.D and Min-Ji Kim, MS from Samsung Biomedical Research Institute, Samsung Medical Centre, for help in the statistical analyses.


The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Boo-Kyung Han.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Seonwoo Kim, Ph.D, Samsung Biomedical Research Institute, Samsung Medical Center helped the statistical analyses of the study.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• diagnostic or prognostic study

• performed at one institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of Radiology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
  2. 2.Department of RadiologyInha University Hospital, Inha University School of MedicineIncheonKorea

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