KEYWORDS: Breast density, Mammography, Magnetic resonance imaging, Radiology, Neodymium, Breast, Breast imaging, Correlation coefficients, Breast cancer, Visualization
The aim of this study is to measure reader agreement for i) lesion classification and ii) breast density in Contrast Enhanced Mammography (CEM). Methods: Two experienced and two inexperienced CEM readers reported 60 examinations. Kappa was used to assess inter-reader agreement between experienced and inexperienced readers for lesion classification (benign/malignant) and breast density (dense/non-dense). Weighted kappa was used to assess agreement for BI-RADS categories (1-5) and BI-RADS density (A-D). Intraclass correlation coefficient (ICC) measured agreement for breast density using Visual Analog scale (VAS). Intra-reader agreement for one experienced and one inexperienced reader was measured after a three month interval. Results: Agreement between experienced readers was substantial (κ=0.66) for benign/malignant, and moderate (κ=0.57) for BI-RADS categories. Agreement for inexperienced readers was moderate for benign/malignant and BI-RADS categories (κ=0.52, κ=0.47 respectively). Breast density (dense/non-dense) agreement was almost perfect for experienced readers (κ=0.83) and substantial for BI-RADS (κ=0.70). Inexperienced reader agreement was moderate for dense/non-dense (κ=0.50) and BI-RADS (κ=0.49). ICC for VAS was moderate for experienced (ICC=0.60) and good (ICC=0.84) for inexperienced readers. Intra-reader agreement for benign/malignant classification was almost perfect for both experienced and inexperienced readers respectively (κ=0.83, κ=0.91). Conclusion: Experienced readers showed substantial agreement for lesion classification and almost perfect agreement for breast density. While inexperienced reader agreement was moderate for both lesion classification and breast density, their agreement for VAS was higher than experienced readers, suggesting that CEM may have a short learning curve and that radiologists could potentially be trained for CEM interpretation, which would help its implementation in other clinical practices in Saudi Arabia.
Breast density is an important risk factor for breast cancer and has a substantial effect on the sensitivity of mammography screening. This study aimed to evaluate intra and inter reader variability of visual breast density assessment in Saudi Arabia, using the American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS) breast density categories (5th edition) and Visual Analogue Scales (VAS). A random sample of 102 screening mammograms from the Saudi National Breast Cancer Screening Programme (SNBCSP) was assessed twice by two breast screening consultant radiologists for intra reader variability. Inter reader variability was assessed using screening mammograms from 1132 women. Each mammogram was assessed by two readers from a pool of 11 radiologists. Inter reader variability for two mammography technologists using a sample of 75 mammograms is also reported. Intra reader variability showed radiologist A had excellent agreement for VAS [Intraclass Correlation Coefficient (ICC) = 0.95] and BI-RADS [weighted kappa (κ) = 0.88], radiologist B had lower but still excellent agreement for VAS [ICC= 0.88] and substantial agreement for BI-RADS [κ = 0.71]. Inter reader variability between radiologists showed overall moderate agreement for BI-RADS [κ =0.61] while VAS had excellent agreement [ICC=0.89]. Results of inter reader agreement between two mammography technologists was fair using BI-RADS [κ= 0.35] and moderate using VAS [ICC=0.41]. In conclusion, agreement in breast density assessment by radiologists in the Saudi breast screening programme is acceptable. Mammography technologists showed lower agreement for both methods. Training is essential to increase reader agreement, double reading is also important in such population based breast cancer screening programmes.
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