Abstract
This study sought to evaluate the association of breast arterial calcification (BAC) on breast screening mammography with the Coronary Artery Disease-Reporting and Data System (CAD-RADS) based on Deep Learning-coronary computed tomography angiography (CCTA). This prospective single institution study included asymptomatic women over 40 who underwent CCTA and breast cancer screening mammography between July 2018 and April 2019. CAD-RADS was scored based on Deep Learning (DL). Mammograms were assessed visually for the presence of BAC. A total of 213 patients were included in the analysis. In comparison to the low CAD-RADS (CAD-RADS < 3) group, the high CAD-RADS (CAD-RADS ≥ 3) group, more often had a history of hypertension (P = 0.036), diabetes (P = 0.017), and chronic kidney disease (P = 0.006). They also had a significantly higher level of LDL-C (P = 0.024), while HDL-C was lower than in the low CAD-RADS group (P = 0.003). BAC was also significantly higher in the high CAD-RADS group (P = 0.002). In multivariate analysis, the presence of BAC [odd ratio (OR) 10.22, 95% CI 2.86–36.49, P < 0.001] maintained a significant associations with CAD-RADS after adjustment by meaningful variable. The same tendency was also found after adjustment by all covariates. There was a significant correlation between the severities of CAD detected by DL based CCTA and BAC in women undergoing breast screening mammography. BAC may be used as an additional diagnostic tool to predict the severity of CAD in this population.
Highlights
Cardiovascular disease (CVD) is the leading cause of mortality and morbidity w orldwide[1,2]
Univariate analysis showed that hypertension, diabetes, chronic kidney disease, high density lipoprotein-C (HDL-C; odd ratio (OR) 0.23, 95% CI 0.09–0.62, P = 0.003), low density lipoprotein-C (LDL-C; OR 2.79, 95% CI 1.15–6.79, P = 0.024) and the presence of breast artery calcifications (BAC) were all significant predictors of coronary artery disease (CAD)-RADS ≥ 3 (Table 2)
In multivariate analysis (Table 3), chronic kidney disease, HDL-C, LDL-C and the presence of BAC maintained significant associations with CAD-RADS after adjustment by meaningful variable, whereas hypertension and diabetes did not
Summary
Cardiovascular disease (CVD) is the leading cause of mortality and morbidity w orldwide[1,2]. Breast cancer affects as many millions of women as CVD and women are commonly screened for breast cancer using mammography. A robust association has been observed between the presence of breast artery calcifications (BAC) and CVD since the association was first reported by Van Noord et al in 19969. A meta-analysis identified the prevalence of BAC as 12.7% by screening mammography s creening[10]. This association between BAC and CAD has been reported only in the US and in other western countries. We aim to develop a DL algorithm for accuracy assessment of CAD and to evaluate the association between BAC on breast screening mammography and CAD-RADS grades based on DL-CCTA in women
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