Volumetric Breast Density Assessment: Reproducibility in Serial Examinations and Comparison with Visual Assessment

Abstract

Background and Purpose: Mammographic breast density is the strongest known marker of breast cancer risk. Visual breast density assessment is subject to significant intra- and inter-rater variability. The aim of the present study was to test the reproducibility of automatic breast density assessment and to compare the results to the visual assessment.

Patients and Methods: Serial mammograms of 141 patients were retrospectively reviewed. Breast density was assessed both visually using a BI-RADS four-category breast density scale and with a software tool for volumetric breast density measurement.

Results: The intra- and inter-rater reproducibility as well as inter-examination reproducibility were assessed for both techniques by calculating the intraclass correlation coefficient (ICC). The inter-examination reproducibility of the volumetric measurement of breast percent density was 0.91 (ICC; 95 % CI 0.87 – 0.93). There was no difference in the strength of the correlation between patients with a large vs. small difference in compression force. The intra- and inter-rater reproducibility ranged from 0.81 – 0.84 and 0.71 – 0.77, respectively. The inter-examination reproducibility of visual assessment was 0.75 – 0.81. The agreement of visual assessment with volumetric measurement was similar to the agreement among readers.

Conclusion: Our results indicate that volumetric breast density measurement provides higher reproducibility in serial examinations than visual assessment and may thus be preferable in the longitudinal assessment of breast density and in the measurement of breast density for risk stratification.

Citation Format:

• Singh JM, Fallenberg EM, Diekmann F et al. Volumetric Breast Density Assessment: Reproducibility in Serial Examinations and Comparison with Visual Assessment. Fortschr Röntgenstr 2013; 185: 844 – 848

Zusammenfassung

Hintergrund und Zielsetzung: Die mammografische Brustdichte ist der stärkste bekannte Marker des Brustkrebsrisikos. Visuell-erhobene Brustdichtebestimmung unterliegt einer großen Intra- und Interrater-Variabilität. Ziel der aktuellen Studie war es die Reproduzierbarkeit der automatischen Brustdichtebestimmung zu testen und die Ergebnisse mit der visuellen Dichtebestimmung zu vergleichen.

Patienten und Methodik: Serielle Mammografieuntersuchungen von 141 Patientinnen wurden retrospektiv untersucht. Die Brustdichte wurde sowohl optisch, anhand der BI-RADS^®-Mammografy-Kriterien für die Brustzusammensetzung, als auch automatisch mit einer Software für volumetrische Dichtemessung bestimmt. Intra- und Interrater-Reproduzierbarkeit wurden für beide Techniken durch Erhebung des Intraklassen-Koeffizienten beurteilt.

Ergebnisse: Interexamination-Reproduzierbarkeit für die volumetrische Bestimmung des Brustparenchymanteils betrug 0,91 (ICC; 95 % CI 0,87 – 0,93). Es bestand kein Unterschied im Ausmaß der Reproduzierbarkeit zwischen Patientinnen mit starker vs. geringer Abweichung der aufgebrachten Kompressionskraft für die unterschiedlichen Untersuchungen. Intra- und Interrater-Variabilität reichten von 0,81 – 0,84 und 0,71 – 0,77. Interexamination-Reproduzierbarkeit des visuellen Assessments betrug 0,75 – 0,81. Übereinstimmung von visuell-erhobener und volumetrischer Dichtebestimmung war vergleichbar mit der Übereinstimmung der Reader untereinander.

Schlussfolgerung: Unsere Ergebnisse zeigen, dass die volumetrische Brustdichtemessung eine höhere Reproduzierkeit für serielle Untersuchungen aufweist als die optische Bestimmung. Die volumetrische Bestimmung könnte daher im longitudinalen Assessment der Brustdichte sowie für die Dichtemessung des Brustgewebes zur Risikostratifizierung der optischen Dichtebestimmung vorzuziehen sein.

Key words

mammography - breast cancer - breast density - volumetric measurement

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