Breast Density Estimation with Fully Automated Volumetric Method:

Comparison to Radiologists' Assessment by BI-RADS Categories
Published:October 27, 2015DOI:

      Rationale and Objectives

      The objective of our study was to calculate mammographic breast density with a fully automated volumetric breast density measurement method and to compare it to breast imaging reporting and data system (BI-RADS) breast density categories assigned by two radiologists.

      Materials and Methods

      A total of 476 full-field digital mammography examinations with standard mediolateral oblique and craniocaudal views were evaluated by two blinded radiologists and BI-RADS density categories were assigned. Using a fully automated software, mean fibroglandular tissue volume, mean breast volume, and mean volumetric breast density were calculated. Based on percentage volumetric breast density, a volumetric density grade was assigned from 1 to 4.


      The weighted overall kappa was 0.895 (almost perfect agreement) for the two radiologists' BI-RADS density estimates. A statistically significant difference was seen in mean volumetric breast density among the BI-RADS density categories. With increased BI-RADS density category, increase in mean volumetric breast density was also seen (P < 0.001). A significant positive correlation was found between BI-RADS categories and volumetric density grading by fully automated software (ρ = 0.728, P < 0.001 for first radiologist and ρ = 0.725, P < 0.001 for second radiologist). Pairwise estimates of the weighted kappa between Volpara density grade and BI-RADS density category by two observers showed fair agreement (κ = 0.398 and 0.388, respectively).


      In our study, a good correlation was seen between density grading using fully automated volumetric method and density grading using BI-RADS density categories assigned by the two radiologists. Thus, the fully automated volumetric method may be used to quantify breast density on routine mammography.

      Key Words

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        • Mainiero M.B.
        • Lourenco A.
        • Mahoney M.C.
        • et al.
        ACR Appropriateness Criteria breast cancer screening.
        J Am Coll Radiol. 2013; 10: 11-14
        • Boyd N.F.
        • Guo H.
        • Martin L.J.
        • et al.
        Mammographic density and the risk and detection of breast cancer.
        N Engl J Med. 2007; 356: 227-236
        • Van Gils C.
        • Otten J.D.
        • Verbeek A.L.
        • et al.
        Mammographic breast density and risk of breast cancer: masking bias or causality?.
        Eur J Epidemiol. 1998; 14: 315-320
        • Mandelson M.T.
        • Oestreicher N.
        • Porter P.L.
        • et al.
        Breast density as a predictor of mammographic detection: comparison of interval- and screen-detected cancers.
        J Natl Cancer Inst. 2000; 92 (Review): 1081-1087
        • Boyd N.F.
        • Martin L.J.
        • Yaffe M.J.
        • et al.
        Mammographic density and breast cancer risk: current understanding and future prospects.
        Breast Cancer Res. 2011; 13: 223
        • 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
        • Vachon C.M.
        • van Gils C.H.
        • Sellers T.A.
        • et al.
        Mammographic density, breast cancer risk and risk prediction.
        Breast Cancer Res. 2007; 9: 217
        • Bertrand K.A.
        • Tamimi R.M.
        • Scott C.G.
        • et al.
        Mammographic density and risk of breast cancer by age and tumour characteristics.
        Breast Cancer Res. 2013; 15: R104
        • 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
        • 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.
        AJR Am J Roentgenol. 2000; 174: 1769-1777
        • 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
        • Spayne M.C.
        • Gard C.C.
        • Skelly J.
        • et al.
        Reproducibility of BI-RADS breast density measures among community radiologists: a prospective cohort study.
        Breast J. 2012; 18: 326-333
        • Byng J.W.
        • Boyd N.F.
        • Fishell E.
        • et al.
        The quantitative analysis of mammographic densities.
        Phys Med Biol. 1994; 39: 1629-1638
        • Sivaramakrishna R.
        • Obuchowski N.A.
        • Chilcote W.A.
        • et al.
        Automatic segmentation of mammographic density.
        Acad Radiol. 2001; 8: 250-256
        • Prevrhal S.
        • Shepherd J.
        • Smith-Bindman R.
        • et al.
        Accuracy of mammographic breast density analysis: results of formal operator training.
        Cancer Epidemiol Biomarkers Prev. 2002; 11: 1389-1393
        • 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
        • Highnam R.
        • Pan X.
        • Warren R.
        • et al.
        Breast composition measurements using retrospective standard mammogram form (SMF).
        Phys Med Biol. 2006; 51: 2695-2713
        • Jeffreys M.
        • Warren R.
        • Highnam R.
        • et al.
        Initial experiences of using an automated volumetric measure of breast density: the standard mammogram form.
        Br J Radiol. 2006; 79: 378-382
        • Highnam R.P.
        • Brady J.M.
        • Shepstone B.J.
        Mammographic image analysis.
        Eur J Radiol. 1997; 24: 20-32
        • D'Orsi C.J.
        • Sickles E.A.
        • Mendelson E.B.
        • et al.
        ACR BI-RADS—breast imaging atlas, breast imaging reporting and data system.
        American College of Radiology, Reston, VA2013
        • Landis J.R.
        • Koch G.G.
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 33: 159-174
        • Harvey J.A.
        • Bovbjerg V.E.
        Quantitative assessment of mammographic breast density: relationship with breast cancer risk.
        Radiology. 2004; 230: 29-41
        • 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.
        AJR Am J Roentgenol. 2013; 201: 692-697
        • Seo J.M.
        • Ko E.S.
        • Han B.K.
        • et al.
        Automated volumetric breast density estimation: a comparison with visual assessment.
        Clin Radiol. 2013; 68: 690-695
        • McEntee M.F.
        • Damases C.N.
        Mammographic density measurement: a comparison of automated volumetric density measurement to BIRADS.
        Proc SPIE Int Soc Opt Eng. 2014;
        • Ko S.Y.
        • Kim E.K.
        • Kim M.J.
        • et al.
        Mammographic density estimation with automated volumetric breast density measurement.
        Korean J Radiol. 2014; 15: 313-321
        • 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
        • Gubern-Mérida A.
        • Kallenberg M.
        • Platel B.
        • et al.
        Volumetric breast density estimation from full field digital mammograms: a validation study.
        PLoS ONE. 2014; 9 (eCollection 2014): e85952
        • Wang J.
        • Aziz A.
        • Newitt D.
        • et al.
        Comparison of Hologic's Quantra volumetric assessment to MRI breast density.
        in: Proceedings of the 11th International Conference on Breast Imaging, IWDM‘12. Springer-Verlag., Berlin, Heidelberg2012: 619-626
        • van Engeland S.
        • Snoeren P.R.
        • Huisman H.
        • et al.
        Volumetric breast density estimation from full-field digital mammograms.
        IEEE Trans Med Imaging. 2006; 25: 273-282
        • Jeffreys M.
        • Harvey J.
        • Highnam R.
        Comparing a new volumetric breast density method (Volpara™) to Cumulus.
        in: Martı' J. IWDM'10: Proceedings of the 10th International Workshop on Digital Mammography. Springer-Verlag, Berlin, Heidelberg2010: 408-413
        • Bernardi D.1.
        • Pellegrini M.
        • Di Michele S.
        • et al.
        Interobserver agreement in breast radiological density attribution according to BI-RADS quantitative classification.
        Radiol Med. 2012; 117: 519-528
        • Eng A.
        • Gallant Z.
        • Shepherd J.
        • et al.
        Digital mammographic breast density and breast cancer risk: a case control study of six alternative density assessment methods.
        Breast Cancer Res. 2014; 16: 439
        • Stone J.
        • Warren R.M.
        • Pinney E.
        • et al.
        Determinants of percentage and area measures of mammographic density.
        Am J Epidemiol. 2009; 170: 1571-1578
        • Aitken Z.
        • McCormack V.A.
        • Highnam R.P.
        • et al.
        Screen-film mammographic density and breast cancer risk: a comparison of the volumetric standard mammogram form and the interactive threshold measurement methods.
        Cancer Epidemiol Biomarkers Prev. 2010; 19: 418-428
        • Jeffreys M.
        • Warren R.
        • Highnam R.
        • et al.
        Breast cancer risk factors and a novel measure of volumetric breast density: cross-sectional study.
        Br J Cancer. 2008; 98: 210-216