Evaluation of Synthesized 2D Mammography Combined with Tomosynthesis: A Potential Approach to Reduce Radiation Exposure in Breast Cancer Diagnostic Exams

Authors

  • Paula Medina Maciel Gomes Curi Bonotto Instituto Nacional de Câncer (INCA). Rio de Janeiro (RJ), Brasil. https://orcid.org/0009-0005-7989-8638
  • Léonie Marie Catherine Lefebvre Université de Rouen Normandie. Rouen, Normandia, França. https://orcid.org/0009-0009-4816-717X
  • Carlos Frederico Motta Vasconcelos Instituto Nacional de Câncer (INCA), Coordenação de Administração Geral (Coage), Serviço de Engenharia Clínica (Seclin). Rio de Janeiro (RJ), Brasil. https://orcid.org/0009-0002-7947-9116
  • Antonio Mauricio Ferreira Leite Miranda de Sá Universidade Federal do Rio de Janeiro (UFRJ), Instituto Alberto Luiz Coimbra de Pós-Graduação e Pesquisa de Engenharia (Coppe). Rio de Janeiro (RJ), Brasil. https://orcid.org/0000-0001-8114-7255
  • Suzana Sales de Aguiar Instituto Nacional de Câncer (INCA), Coordenação de Pesquisa Clínica, Divisão de Pesquisa Clínica e Desenvolvimento Tecnológico. Rio de Janeiro (RJ), Brasil. https://orcid.org/0000-0003-1963-1294
  • Anke Bergmann Instituto Nacional de Câncer (INCA), Coordenação de Pesquisa Clínica, Divisão de Pesquisa Clínica e Desenvolvimento Tecnológico. Rio de Janeiro (RJ), Brasil. https://orcid.org/0000-0002-1972-8777

DOI:

https://doi.org/10.32635/2176-9745.RBC.2026v72n1.5470

Keywords:

Mammography/instrumentation, Breast Neoplasms/diagnostic imaging, Early Detection of Cancer, Mass Screening

Abstract

Introduction: Breast cancer is the most common globally among the female population. Conventional 2D Full-Field Digital Mammography (FFDM) is the standard screening tool but limited in dense breasts. Digital Breast Tomosynthesis (DBT) reduces this limitation, especially in extremely dense and heterogeneously dense breasts; however, its routine combination with FFDM increases radiation exposure. Synthesized 2D Mammography (S2D) has been proposed as alternative to replace FFDM, reducing dose while maintaining diagnostic performance. Objective: Validate S2D as replacement for FFDM in breast cancer diagnostic to reduce radiation dose without compromising diagnostic accuracy. Method: Patients with suspected breast lesions have been evaluated at the National Cancer Institute (INCA). Images were obtained using combined protocol (FFDM+DBT), and S2D images were generated from DBT. Agreement between FFDM and S2D was assessed using Cohen ́s Kappa. Diagnostic accuracy, sensitivity, and specificity of each imaging modality and their combinations were compared with percutaneous biopsy results. Results: Of the 149 patients included in this study, 75% had either dense or extremely dense breast tissue. Synthesized 2D showed excellent agreement with FFDM in lesion detection (κ= 0.757) and classification (κ= 0.867). DBT achieved 100% sensitivity for malignant lesions. The S2D+DBT combination demonstrated accuracy of 98.6% and sensitivity of 100%, comparable to FFDM+DBT but with 47.8% reduction in radiation dose. Conclusion: Synthesized 2D mammography is a reliable alternative to FFDM. Combined with DBT, S2D also provides accurate detection while significantly reducing radiation exposure, supporting its integration into breast cancer screening protocols, particularly in resource-constrained healthcare systems.

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Published

2025-12-22

How to Cite

1.
Bonotto PMMGC, Lefebvre LMC, Vasconcelos CFM, Sá AMFLM de, Aguiar SS de, Bergmann A. Evaluation of Synthesized 2D Mammography Combined with Tomosynthesis: A Potential Approach to Reduce Radiation Exposure in Breast Cancer Diagnostic Exams. Rev. Bras. Cancerol. [Internet]. 2025 Dec. 22 [cited 2026 Jan. 7];72(1):e-235470. Available from: https://rbc.inca.gov.br/index.php/revista/article/view/5470

Issue

Vol. 72 No. 1 (2026): Jan./Feb./Mar.

Section

ORIGINAL ARTICLE

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