Comparison of two-dimensional synthesized mammograms versus original digital mammograms: a quantitative assessment


This study objectively evaluates the similarity between standard full-field digital mammograms and two-dimensional synthesized digital mammograms (2DSM) in a cohort of women undergoing mammography. Under an institutional review board–approved data collection protocol, we retrospectively analyzed 407 women with digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM) examinations performed from September 1, 2014, through February 29, 2016. Both FFDM and 2DSM images were used for the analysis, and 3216 available craniocaudal (CC) and mediolateral oblique (MLO) view mammograms altogether were included in the dataset. We analyzed the mammograms using a fully automated algorithm that computes 152 structural similarity, texture, and mammographic density–based features. We trained and developed two different global mammographic image feature analysis–based breast cancer detection schemes for 2DSM and FFDM images, respectively. The highest structural similarity features were obtained on the coarse Weber Local Descriptor differential excitation texture feature component computed on the CC view images (0.8770) and MLO view images (0.8889). Although the coarse structures are similar, the global mammographic image feature–based cancer detection scheme trained on 2DSM images outperformed the corresponding scheme trained on FFDM images, with area under a receiver operating characteristic curve (AUC) = 0.878 ± 0.034 and 0.756 ± 0.052, respectively. Consequently, further investigation is required to examine whether DBT can replace FFDM as a standalone technique, especially for the development of automated objective-based methods.

Graphical abstract

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Fig. 1
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Fig. 5



Digital breast tomosynthesis


Full-field digital mammography




Mediolateral oblique




2D synthesized mammogram


Percentage density


Structural similarity index metric


Complex wavelet-structural similarity index metric


Correlation-based SSIM


Correlation-based CW-SSIM


Weber Local Descriptor


Linear discriminant analysis


Receiver operating characteristic


Area under a ROC curve


Confidence interval


Food and Drug Administration


Peak signal-to-noise


Scale-invariant feature transform


Local binary pattern


Run-length statistic


Gray level co-occurrence matrix




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The authors acknowledge Dr. Nazimah Ab Mumin from University Teknologi Mara for contributing most of the images used in this study.


This study was funded by the Electrical and Computer Systems Engineering and Advanced Engineering Platform, School of Engineering, Monash University Malaysia, and the University of Malaya Research Grant (Grant Number: PO035-2015).

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Correspondence to Maxine Tan.

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Tan, M., Al-Shabi, M., Chan, W.Y. et al. Comparison of two-dimensional synthesized mammograms versus original digital mammograms: a quantitative assessment. Med Biol Eng Comput 59, 355–367 (2021).

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  • Mammography
  • Algorithms
  • Breast density
  • Two-dimensional synthesized mammograms
  • Structural similarity