Volumetric breast density measurement for personalized screening: accuracy, reproducibility, consistency, and agreement with visual assessment.

Andreas Fieselmann,Daniel Förnvik

doi:10.1117/1.jmi.6.3.031406

Abstract

Assessment of breast density at the point of mammographic examination could lead to optimized breast cancer screening pathways. The onsite breast density information may offer guidance of when to recommend supplemental imaging for women in a screening program. A software application (Insight BD, Siemens Healthcare GmbH) for fast onsite quantification of volumetric breast density is evaluated. The accuracy of the method is assessed using breast tissue equivalent phantom experiments resulting in a mean absolute error of 3.84%. Reproducibility of measurement results is analyzed using 8427 exams in total, comparing for each exam (if available) the densities determined from left and right views, from cranio-caudal and medio-lateral oblique views, from full-field digital mammograms (FFDM) and digital breast tomosynthesis (DBT) data and from two subsequent exams of the same breast. Pearson correlation coefficients of 0.937, 0.926, 0.950, and 0.995 are obtained. Consistency of the results is demonstrated by evaluating the dependency of the breast density on women's age. Furthermore, the agreement between breast density categories computed by the software with those determined visually by 32 radiologists is shown by an overall percentage agreement of 69.5% for FFDM and by 64.6% for DBT data. These results demonstrate that the software delivers accurate, reproducible, and consistent measurements that agree well with the visual assessment of breast density by radiologists.

Highlights

1.1 Clinical BackgroundBreast density is an important topic in breast cancer screening because of two aspects
A high amount of dense breast tissue is considered to be an independent risk factor for developing breast cancer, and second, sensitivity of mammography is lower in dense breasts due to the masking effect.[1]
Supplemental imaging for dense breasts [e.g., breast ultrasound, breast magnetic resonance imaging (MRI)] can be useful to increase cancer detection rates in breast cancer screening.[2]

Summary

Introduction

Breast density is an important topic in breast cancer screening because of two aspects. A high amount of dense (fibroglandular) breast tissue is considered to be an independent risk factor for developing breast cancer, and second, sensitivity of mammography is lower in dense breasts due to the masking effect.[1] Supplemental imaging for dense breasts [e.g., breast ultrasound, breast magnetic resonance imaging (MRI)] can be useful to increase cancer detection rates in breast cancer screening.[2] Nowadays, the majority of the US states require that women are informed if they have dense breast tissue and they will receive information about supplemental imaging options.[3,4]. Radiologists typically estimate breast density during interpretation of the mammograms. Visual breast density assessment is known to have considerable intra- and inter-reader variability.[5] Automated breast density assessment by computer software is increasingly used to assist radiologists in reporting breast density more objectively and consistently

Methods

Results

Discussion

Conclusion