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 breast cancer risk factor related to decreased mammography sensitivity and as an independent risk factor. This research aims to establish the distribution of breast density in the Saudi screening population and to identify the relationship between visual and automated breast density methods. Screening mammograms from 2905 cancer-free women were retrospectively collected from the Saudi National Breast Cancer Screening Programme. Breast density of screening mammograms were assessed visually by 11 radiologists using the Breast Imaging and Reporting Data System (BIRADS) 5th edition and Visual Analogue Scale (VAS), and by automated methods; predicted VAS processed (pVASprocessed), predicted VAS raw (pVASraw) and VolparaTM. The relationship between breast density methods was assessed using the intra-class coefficient (ICC) and weighted kappa (κ). Results indicated that around one-third of Saudi women of screening age had high breast density (BI-RADS C/D: 31.5% or Volpara Density Grade (VDG) C/D: 29.0%). Full screening mammograms from 1022 women were used to assess the relationship between all methods. Predicted VAS estimates of percent density were generally lower than VAS. The highest ICC was between VAS and pVASraw (ICC=0.86, 95% CI 0.84-0.88). For categorical breast density methods, VDG 5th edition showed fair agreement with BI-RADS 5th edition (κ=0.35, 95% CI 0.29-0.39). In conclusion, this study shows the majority of Saudi women of screening age have low breast density as shown by visual and automated methods, and there is a positive relationship between visual and automated methods, being strongest for VAS and pVASraw.
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