Breast AI Tomosynthesis and Synthesized-2D Scores Not Interchangeable, Add Limited Value Over Clinical Assessment

In 139 biopsy-referred breasts, tomosynthesis and synthesized-2D AI malignancy scores showed only moderate agreement (κ=0.53) despite similar AUCs (0.728 vs 0.717). Adding either score to a clinical model improved fit but not discrimination meaningfully. Do not downgrade a suspi…

• Among malignant breasts, 21 were flagged only by the tomosynthesis AI output versus 6 only by synthesized-2D (p=0.006).
• Of 30 cancers negative by tomosynthesis AI, 25 had no mammographic correlate on blinded re-review; breast density did not fully explain this.
• Prospective, multireader, multicenter validation is required before implementing these distinct outputs in clinical decision-making.

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