Automated Volumetric Mammographic Breast Density Measurements May Underestimate Percent Breast Density for High-density Breasts

      Rationale and Objectives

      The purpose of this study was to evaluate discrepancy in breast composition measurements obtained from mammograms using two commercially available software methods for systematic trends in overestimation or underestimation compared to magnetic resonance-derived measurements.

      Materials and Methods

      An institutional review board-approved, Health Insurance Portability and Accountability Act-compliant retrospective study was performed to calculate percent breast density (PBD) by quantifying fibroglandular volume and total breast volume derived from magnetic resonance imaging (MRI) segmentation and mammograms using two commercially available software programs (Volpara and Quantra). Consecutive screening MRI exams from a 6-month period with negative or benign findings were used. The most recent mammogram within 9 months was used to derive mean density values from “for processing” images at the per breast level. Bland-Altman statistical analyses were performed to determine the mean discrepancy and the limits of agreement.


      A total of 110 women with 220 breasts met the study criteria. Overall, PBD was not different between MRI (mean 10%, range 1%–41%) and Volpara (mean 10%, range 3%–29%); a small but significant difference was present in the discrepancy between MRI and Quantra (4.0%, 95% CI: 2.9 to 5.0, P < 0.001). Discrepancy was highest at higher breast densities, with Volpara slightly underestimating and Quantra slightly overestimating PBD compared to MRI. The mean discrepancy for both Volpara and Quantra for total breast volume was not significantly different from MRI (p = 0.89, 0.35, respectively). Volpara tended to underestimate, whereas Quantra tended to overestimate fibroglandular volume, with the highest discrepancy at higher breast volumes.


      Both Volpara and Quantra tend to underestimate PBD, which is most pronounced at higher densities. PBD can be accurately measured using automated volumetric software programs, but values should not be used interchangeably between vendors.

      Key Words

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