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A Reliability Comparison of Cone-Beam Breast Computed Tomography and Mammography: Breast Density Assessment Referring to the Fifth Edition of the BI-RADS Atlas

  • Author Footnotes
    1 These authors contributed equally to this work.
    Yue Ma
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin’s Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, PR China
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  • Author Footnotes
    1 These authors contributed equally to this work.
    Yang Cao
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Ultrasound, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, PR China
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  • Aidi Liu
    Affiliations
    Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin’s Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, PR China
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  • Lu Yin
    Affiliations
    Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin’s Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, PR China
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  • Peng Han
    Affiliations
    Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin’s Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, PR China
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  • Haijie Li
    Affiliations
    Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin’s Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, PR China
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  • Xiaohua Zhang
    Affiliations
    Koning Corporation, West Henrietta, New York
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  • Zhaoxiang Ye
    Correspondence
    Address correspondence to: Z.Y.
    Affiliations
    Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin’s Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, PR China
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  • Author Footnotes
    1 These authors contributed equally to this work.
Published:September 13, 2018DOI:https://doi.org/10.1016/j.acra.2018.07.023

      Rationale and Objectives

      To evaluate the reliability of cone-beam breast computed tomography (CBBCT) in visual assessment of breast density referring to the fifth edition of the Breast Imaging Reporting and Data System compared to digital mammography.

      Materials and Methods

      Breast density assessments of 130 female patients were performed by five radiologists referring to the fifth edition of Breast Imaging Reporting and Data System atlas both on two-view mammograms and CBBCT images. Assessments were repeated by three radiologists with different experience more than 1 month after the initial evaluation. The inter- and intrareader agreements were compared by using the Cohen's weighted Kappa statistic and intraclass correlation coefficient. Weighted Kappa statistic was also used to analyze the agreement between CBBCT images and mammograms. The influence of radiologist experience for breast density assessment was analyzed using a chi-square test.

      Results

      For CBBCT images, the inter-reader agreement was 0.781, whereas the agreement on mammograms was 0.744, both demonstrating moderate agreement. The level of intrareader reliability was higher on the CBBCT images than mammograms for breast density evaluation, 0.856 versus 0.786. Based on the majority report, the agreement between these two modalities was on substantial agreement degree. There was a statistically significant difference among radiologists with different levels of experience, and higher density categories were reported more often by experienced reader.

      Conclusion

      CBBCT showed equal aptitude and better agreement for the breast density evaluation compared to mammography. CBBCT could be an effective modality for breast density assessment and breast cancer risk evaluation in routine diagnosis and breast cancer screening.

      Key Words

      Abbreviations:

      3D (three-dimensional), 95% CI (95% confidence interval), BI-RADS (Breast Imaging Reporting and Data System), CBBCT (cone-beam breast computed tomography), ICC (intraclass correlation coefficient)
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      References

        • McGuire S.
        World Cancer Report 2014. Geneva, Switzerland: World Health Organization, International Agency for Research on Cancer, WHO Press, 2015.
        Adv Nutr. 2016; 7: 418-419
        • Rojas K.
        • Stuckey A.
        Breast cancer epidemiology and risk factors.
        Clin Obstet Gynecol. 2016; 59: 651-672
        • Boyd N.F.
        • Guo H.
        • Martin L.J.
        • et al.
        Mammographic density and the risk and detection of breast cancer.
        New Engl J Med. 2007; 356: 227-236
        • Schreer I.
        Dense breast tissue as an important risk factor for breast cancer and implications for early detection.
        Breast Care. 2009; 4: 89-92
        • Raghavendra A.
        • Sinha A.K.
        • Le-Petross H.T.
        • et al.
        Mammographic breast density is associated with the development of contralateral breast cancer.
        Cancer. 2017; 123: 1935-1940
        • Wolfe J.N.
        Risk for breast cancer development determined by mammographic parenchymal pattern.
        Cancer. 1976; 37: 2486-2492
        • van Gils C.H.
        • Otten J.D.M.
        • Verbeek A.L.M.
        • et al.
        Effect of mammographic breast density on breast cancer screening performance: a study in Nijmegen, the Netherlands.
        J Epidemiol Commun Health. 1998; 52: 267-271
        • Buist D.S.M.
        • Porter P.L.
        • Lehman C.
        • et al.
        Factors contributing to mammography failure in women aged 40-49 years.
        J Natl Cancer Inst. 2004; 96: 1432-1440
        • Pinsky R.W.
        • Helvie M.A.
        Mammographic breast density: effect on imaging and breast cancer risk.
        J Natl Compr Canc Netw. 2010; 8: 1157-1164
        • Yun S.J.
        • Ryu C.W.
        • Rhee S.J.
        • et al.
        Benefit of adding digital breast tomosynthesis to digital mammography for breast cancer screening focused on cancer characteristics: a meta-analysis.
        Breast Cancer Res Treat. 2017; 164: 557-569
        • D'Orsi C.
        • Sickles E.
        • Mendelson E.
        • et al.
        ACR BI-RADS® Atlas.
        Breast Imaging Reporting and Data System, 2013
        • Taif S.A.
        Breast magnetic resonance imaging indications in current practice.
        Asian Pac J Cancer Prev. 2014; 15: 569-575
        • Tagliafico A.S.
        • Calabrese M.
        • Mariscotti G.
        • et al.
        Adjunct screening with tomosynthesis or ultrasound in women with mammography-negative dense breasts: interim report of a prospective comparative trial.
        J Clin Oncol. 2016; 34: 1882-1888
        • Hylton N.
        Magnetic resonance imaging of the breast: opportunities to improve breast cancer management.
        J Clin Oncol. 2005; 23: 1678-1684
        • Linder J.M.
        • Schiska A.D.
        Progress in diagnosis of breast cancer: advances in radiology technology.
        Asia Pac J Oncol Nurs. 2015; 2: 186-1891
        • O'Connell A.M.
        • Karellas A.
        • Vedantham S.
        The potential role of dedicated 3D breast CT as a diagnostic tool: review and early clinical examples.
        Breast J. 2014; 20: 592-605
        • O'Connell A.
        • Conover D.L.
        • Zhang Y.
        • et al.
        Cone-beam CT for breast imaging: radiation dose, breast coverage, and image quality.
        AJR Am J Roentgenol. 2010; 195: 496-509
        • O'Connell A.M.
        • Kawakyu-O'Connor D.
        Dedicated cone-beam breast computed tomography and diagnostic mammography: comparison of radiation dose, patient comfort, and qualitative review of imaging findings in BI-RADS 4 and 5 lesions.
        J Clin Imaging Sci. 2012; 2: 7
        • He N.
        • Wu Y.P.
        • Kong Y.
        • et al.
        The utility of breast cone-beam computed tomography, ultrasound, and digital mammography for detecting malignant breast tumors: a prospective study with 212 patients.
        Eur J Radiol. 2016; 85: 392-403
        • Wienbeck S.
        • Uhlig J.
        • Luftner-Nagel S.
        • et al.
        The role of cone-beam breast-CT for breast cancer detection relative to breast density.
        Eur Radiol. 2017; 27: 5185-5195
        • Yang W.T.
        • Carkaci S.
        • Chen L.
        • et al.
        Dedicated cone-beam breast CT: feasibility study with surgical mastectomy specimens.
        AJR Am J Roentgenol. 2007; 189: 1312-1315
        • Landis J.R.
        • Koch G.G.
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 33: 159-174
        • 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
        • Ooms E.A.
        • Zonderland H.M.
        • Eijkemans M.J.
        • et al.
        Mammography: interobserver variability in breast density assessment.
        Breast. 2007; 16: 568-576
        • Ekpo E.U.
        • Ujong U.P.
        • Mello-Thoms C.
        • et al.
        Assessment of inter-radiologist agreement regarding mammographic breast density classification using the fifth edition of the BI-RADS atlas.
        AJR Am J Roentgenol. 2016; 206: 1119-1123
        • Liu J.
        • Liu P.F.
        • Li J.N.
        • et al.
        Analysis of mammographic breast density in a group of screening Chinese women and breast cancer patients.
        Asian Pac J Cancer Prev. 2014; 15: 6411-6414
        • Youk J.H.
        • Kim S.J.
        • Son E.J.
        • et al.
        Comparison of visual assessment of breast density in BI-RADS 4th and 5th editions with automated volumetric measurement.
        AJR Am J Roentgenol. 2017; 209: 703-708