BEYOND THE PIXEL: CAN SYNTHETIC 2D MAMMOGRAPHY DELIVER WHAT DIGITAL CAN'T

Objective: This study aimed to compare two-dimensional (2D) synthetic mammography (SM) and conventional 2D full-field digital mammography (FFDM) in the evaluation of breast lesions. We aim to determine whether SM, when combined with digital breast tomosynthesis (DBT), can serve as a new standard suitable for clinical adoption. This potential shift could impact existing screening protocols, offering benefits such as improved patient outcomes, maintained diagnostic accuracy, and workflow efficiency. Implementing SM+DBT may reduce radiation exposure, streamline image acquisition, and maintain diagnostic detail. This protocol could also increase patient throughput by minimizing image capture time and may enable more frequent, guideline-aligned screenings, ultimately supporting healthcare delivery efficiency from a clinical perspective. Mammograms from 100 patients wi Material And Method: th suspected breast pathologies were obtained using the Hologic Selenia Dimensions System in COMBO HD mode, generating FFDM, DBT, and SM images. FFDM and SM images were independently assessed using the 5th edition ACR Breast Imaging Reporting and Data System (5th edition BI-RADS) lexicon and compared. Institutional review board approval and patient consent were obtained. Spiculated margins and fine Result: pleomorphic calcifications were more distinctly visualised on SM images. FFDM images provided a more precise visualisation of nipple retraction and skin thickening. There was no significant difference in average glandular dose between FFDM and SM images (p = 0.12). BIRADS categorisation showed complete agreement across both methods in all cases. FFDM and SM images Conclusion: provided equivalent diagnostic performance for breast lesion evaluation. Combining DBT with SM reduced patient radiation dose without compromising diagnostic accuracy. Synthetic mammography may be considered a viable alternative to full-field digital mammogra Advances In Knowledge: phy when combined with digital breast tomosynthesis.