Abstract
Discussions of percent breast density (PD) and breast cancer risk implicitly assume that visual assessments of PD are comparable between vendors despite differences in technology and display algorithms. This study examines the extent to which visual assessments of PD differ between mammograms acquired from two vendors. Pairs of "for presentation" digital mammography images were obtained from two mammography units for 146 women who had a screening mammogram on one vendor unit followed by a diagnostic mammogram on a different vendor unit. Four radiologists independently visually assessed PD from single left mediolateral oblique view images from the two vendors. Analysis of variance, intra-class correlation coefficients (ICC), scatter plots, and Bland-Altman plots were used to evaluate PD assessments between vendors. The mean radiologist PD for each image was used as a consensus PD measure. Overall agreement of the PD assessments was excellent between the two vendors with an ICC of 0.95 (95% confidence interval: 0.93 to 0.97). Bland-Altman plots demonstrated narrow upper and lower limits of agreement between the vendors with only a small bias (2.3 percentage points). The results of this study support the assumption that visual assessment of PD is consistent across mammography vendors despite vendor-specific appearances of "for presentation" images.
Highlights
Percent mammographic breast density (PD) determined from “for presentation” mammography images is a well-known risk factor for breast cancer.[1,2,3,4] Discussion of PD in the medical literature, that pertaining to multisite studies, implicitly assumes that visual assessments of PD are comparable across mammograms generated by different vendors
Vendor-specific differences in the appearance of the “for presentation” mammography images routinely reviewed in clinical care may contribute to the unreliability of visual assessments of PD, in cases when data are pooled across multiple sites
While the PD assessments for Siemens images were marginally higher than those of Hologic images across all raters, the mixed effects analysis of variance (ANOVA) demonstrated that this effect did not differ across raters
Summary
Percent mammographic breast density (PD) determined from “for presentation” mammography images is a well-known risk factor for breast cancer.[1,2,3,4] Discussion of PD in the medical literature, that pertaining to multisite studies, implicitly assumes that visual assessments of PD are comparable across mammograms generated by different vendors. Vendor-specific differences in the appearance of the “for presentation” mammography images routinely reviewed in clinical care may contribute to the unreliability of visual assessments of PD, in cases when data are pooled across multiple sites
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