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Mammographic Breast Density Assessment Using Automated Volumetric Software and Breast Imaging Reporting and Data System (BIRADS) Categorization by Expert Radiologists

  • Christine N. Damases
    Correspondence
    Address correspondence to: C.N.D.
    Affiliations
    Faculty of Health Sciences, Discipline of Medical Radiation Sciences and Brain and Mind Research Institute, M205, Cumberland Campus, The University of Sydney, 75 East St, Room M205, Lidcombe, Sydney, NSW 2141, Australia

    Faculty of Health Sciences, Department of Radiography, University of Namibia, M-Block, Room M-105, Mandume Ndemufayo Avenue, Private Bag 13310, Windhoek 9000, Namibia
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  • Patrick C. Brennan
    Affiliations
    Faculty of Health Sciences, Discipline of Medical Radiation Sciences and Brain and Mind Research Institute, M205, Cumberland Campus, The University of Sydney, 75 East St, Room M205, Lidcombe, Sydney, NSW 2141, Australia
    Search for articles by this author
  • Claudia Mello-Thoms
    Affiliations
    Faculty of Health Sciences, Discipline of Medical Radiation Sciences and Brain and Mind Research Institute, M205, Cumberland Campus, The University of Sydney, 75 East St, Room M205, Lidcombe, Sydney, NSW 2141, Australia
    Search for articles by this author
  • Mark F. McEntee
    Affiliations
    Faculty of Health Sciences, Discipline of Medical Radiation Sciences and Brain and Mind Research Institute, M205, Cumberland Campus, The University of Sydney, 75 East St, Room M205, Lidcombe, Sydney, NSW 2141, Australia
    Search for articles by this author
Published:October 27, 2015DOI:https://doi.org/10.1016/j.acra.2015.09.011

      Rationale and Objectives

      To investigate agreement on mammographic breast density (MD) assessment between automated volumetric software and Breast Imaging Reporting and Data System (BIRADS) categorization by expert radiologists.

      Materials and Methods

      Forty cases of left craniocaudal and mediolateral oblique mammograms from 20 women were used. All images had their volumetric density classified using Volpara density grade (VDG) and average volumetric breast density percentage. The same images were then classified into BIRADS categories (I–IV) by 20 American Board of Radiology examiners.

      Results

      The results demonstrated a moderate agreement (κ = 0.537; 95% CI = 0.234–0.699) between VDG classification and radiologists' BIRADS density assessment. Interreader agreement using BIRADS also demonstrated moderate agreement (κ = 0.565; 95% CI = 0.519–0.610) ranging from 0.328 to 0.669. Radiologists' average BIRADS was lower than average VDG scores by 0.33, with their mean being 2.13, whereas the mean VDG was 2.48 (U = −3.742; P < 0.001). VDG and BIRADS showed a very strong positive correlation (ρ = 0.91; P < 0.001) as did BIRADS and average volumetric breast density percentage (ρ = 0.94; P < 0.001).

      Conclusions

      Automated volumetric breast density assessment shows moderate agreement and very strong correlation with BIRADS; interreader variations still exist within BIRADS. Because of the increasing importance of MD measurement in clinical management of patients, widely accepted, reproducible, and accurate measures of MD are required.

      Key Words

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      References

        • McCormack V.A.
        • dos Santos Silva I.
        Breast density and parenchymal patterns as markers of breast cancer risk: a meta-analysis.
        Cancer Epidemiol Biomarkers Prev. 2006; 15: 1159-1169
        • Ursin G.Q.S.
        Mammographic density—a useful biomarker for the breast cancer risk in epidemiologic studies.
        Norsk Epidermiologi. 2009; 19: 59-68
        • Yaffe M.J.
        Mammographic density. Measurement of mammographic density.
        Breast Cancer Res. 2008; 10: 209
        • Harvey J.A.
        • Bovbjerg V.E.
        Quantitative assessment of mammographic breast density: relationship with breast cancer risk.
        Radiology. 2004; 230: 29-41
        • Ng K.H.
        • Yip C.H.
        • Taib N.A.M.
        Standardisation of clinical breast-density measurement.
        Lancet Oncol. 2012; 13: 334-336
        • Shepherd J.A.
        • Kerlikowske K.
        • Ma L.
        • et al.
        Volume of mammographic density and risk of breast cancer.
        Cancer Epidemiol Biomarkers Prev. 2011; 20: 1473-1482
        • D'Orsi C.J.
        • Bassett L.W.
        • Berg W.A.
        • et al.
        BI-RADS mammography.
        in: D'Orsi C.J. Mendelson E.B. Ikeda D.M. Breast imaging reporting and data system: ACR BI-RADS—breast imaging atlas. 4th ed. American College of Radiology, Reston, VA2003: 61-128
        • Radiology ACo
        The American College of radiology BIRADS ATLAS and MQSA: frequently asked questions.
        (Available at:) (Accessed September 25)
        • Radiology ACo
        BI-RADS mammography 2013-ACR BI-RADS atlas.
        5th ed. 2014 (Available at:) (Accessed March 17)
        • Andersson I.
        • Ikeda D.M.
        • Zackrisson S.
        • et al.
        Breast tomosynthesis and digital mammography: a comparison of breast cancer visibility and BIRADS classification in a population of cancers with subtle mammographic findings.
        Eur Radiol. 2008; 18: 2817-2825
        • Duffy S.W.
        • Nagtegaal I.D.
        • Astley S.M.
        • et al.
        Visually assessed breast density, breast cancer risk and the importance of the craniocaudal view.
        Breast Cancer Res. 2008; 10: R64
        • Nicholson B.T.
        • LoRusso A.P.
        • Smolkin M.
        • et al.
        Accuracy of assigned BI-RADS breast density category definitions.
        Acad Radiol. 2006; 13: 1143-1149
        • Zhou C.
        • Chan H.P.
        • Petrick N.
        • et al.
        Computerized image analysis: estimation of breast density on mammograms.
        Med Phys. 2001; 28: 1056-1069
        • McCormack V.A.
        • Highnam R.
        • Perry N.
        • et al.
        Comparison of a new and existing method of mammographic density measurement: intramethod reliability and associations with known risk factors.
        Cancer Epidemiol Biomarkers Prev. 2007; 16: 1148-1154
        • Ciatto S.
        • Bernardi D.
        • Calabrese M.
        • et al.
        A first evaluation of breast radiological density assessment by QUANTRA software as compared to visual classification.
        Breast. 2012; 21: 503-506
        • Ooms E.A.
        • Zonderland H.M.
        • Eijkemans M.J.C.
        • et al.
        Mammography: interobserver variability in breast density assessment.
        Breast. 2007; 16: 568-576
        • Highnam R.
        • Brady M.
        • Yaffe M.J.
        • et al.
        Robust breast composition measurement: Volpara.
        in: Marti J. Oliver A. Freixenet J. Digital mammography. 2010: 342-349
        • Tagliafico A.
        • Tagliafico G.
        • Tosto S.
        • et al.
        Mammographic density estimation: comparison among BI-RADS categories, a semi-automated software and a fully automated one.
        Breast. 2009; 18: 35-40
        • Byng J.W.
        • Boyd N.F.
        • Fishell E.
        • et al.
        Automated analysis of mammographic densities.
        Phys Med Biol. 1996; 41: 909-923
        • Alonzo-Proulx O.
        • Mawdsley G.E.
        • Patrie J.T.
        • et al.
        Reliability of automated breast density measurement.
        Radiology. 2015; 275: 366-376
        • Sauber N.
        • Chan A.
        • Highnam R.
        BI-RADS breast density classification—an international standard.
        (ECR)2013
        • Wang K.
        • Chan A.
        • Highnam R.
        Robustness of automated volumetric breast density estimation for assessing temporal changes in breast density.
        (ECR)2015
        • Gweon H.M.
        • Youk J.H.
        • Kim J.A.
        • et al.
        Radiologist assessment of breast density by BI-RADS categories versus fully automated volumetric assessment.
        Am J Roentgenol. 2013; 201: 692-697
        • Damases C.N.
        • Brennan P.C.
        • McEntee M.F.
        Mammographic density measurements are not affected by mammography system.
        J Med Imag. 2015; 2: 15501-15505
        • McEntee M.F.
        • Damases C.N.
        Mammographic density measurement: a comparison of automated volumetric density measurement to BIRADS.
        Med Imag 2014: Image Percept, Obs Perform, Technol Assess. 2014; 9037: 8
        • Wanders J.O.
        • Holland K.
        • Veldhuis W.B.
        • et al.
        Effect of volumetric mammographic density on performance of a breast cancer screening program using full-field digital mammography.
        (ECR)2015
        • Börjesson S.
        • Håkansson M.
        • Båth M.
        • et al.
        A software tool for increased efficiency in observer performance studies in radiology.
        Radiat Prot Dosimetry. 2005; 114: 45-52
        • Brennan P.C.
        • McEntee M.
        • Evanoff M.
        • et al.
        Ambient lighting: effect of illumination on soft-copy viewing of radiographs of the wrist.
        Am J Roentgenol. 2007; 188: W177-W180
        • Volpara Solutions
        Volpara clinical breast density and its implications for your patients.
        (Available at:) (Accessed March 27)
        • Berg W.A.
        • Campassi C.
        • Langenberg P.
        • et al.
        Breast imaging reporting and data system: inter- and intraobserver variability in feature analysis and final assessment.
        Am J Roentgenol. 2000; 174: 1769-1777
        • Viera A.J.
        • Garrett J.M.
        Understanding interobserver agreement: the kappa statistic.
        Fam Med. 2005; 37: 360-363
        • Martin K.E.
        • Helvie M.A.
        • Zhou C.
        • et al.
        Mammographic density measured with quantitative computer-aided method: comparison with radiologists' estimates and BI-RADS categories.
        Radiology. 2006; 240: 656-665
        • Ciatto S.
        • Houssami N.
        • Apruzzese A.
        • et al.
        Categorizing breast mammographic density: intra- and interobserver reproducibility of BI-RADS density categories.
        Breast. 2005; 14: 269-275
        • Kerlikowske K.
        • Grady D.
        • Barclay J.
        • et al.
        Variability and accuracy in mammographic interpretation using the American College of Radiology Breast Imaging Reporting and Data System.
        J Natl Cancer Inst. 1998; 90: 1801-1809
        • Jeffreys M.
        • Harvey J.
        • Highnam R.
        Comparing a new volumetric breast density method (Volpara™) to Cumulus.
        in: Marti J. Oliver A. Freixenet J. Digital mammography. Springer-Verlag Berlin, Berlin2010: 408-413
        • Byng J.W.
        • Boyd N.F.
        • Fishell E.
        • et al.
        The quantitative analysis of mammographic densities.
        Phys Med Biol. 1994; 39: 1629-1638
        • Byng J.W.
        • Yaffe M.J.
        • Jong R.A.
        • et al.
        Analysis of mammographic density and breast cancer risk from digitized mammograms.
        Radiographics. 1998; 18: 1587-1598
        • Boyd N.F.
        • Byng J.W.
        • Jong R.A.
        • et al.
        Quantitative classification of mammographic densities and breast cancer risk: results from the Canadian National Breast Screening Study.
        J Natl Cancer Inst. 1995; 87: 670-675
        • Morris O.W.E.
        • Tucker L.
        • Black R.
        • et al.
        Mammographic breast density: comparison of methods for qualitative evaluation.
        Radiology. 2015; 275: 356-365
        • Holland K.
        • Kallenberg M.
        • Mann R.
        • et al.
        Stability of volumetric tissue composition measured in serial screening mammograms.
        in: Fujita H. Hara T. Muramatsu C. Breast imaging. Springer International Publishing, Switzerland2014: 239-244
        • Schilling K.
        • The J.
        • Griff S.
        • et al.
        Impact of quantitative breast density on experienced radiologists' assessment of mammographic breast density. European Congress of Radiology, Vienna, Austria2015 (C-1281)
        • Elmore J.G.
        • Wells C.K.
        • Lee C.H.
        • et al.
        Variability in radiologists' interpretations of mammograms.
        NEJM. 1994; 331: 1493-1499