Breast density (BD) assessment with digital breast tomosynthesis (DBT): Agreement between Quantra™ and 5th edition BI-RADS®

Ernest U Ekpo; Claudia Mello-Thoms; Mary Rickard; Patrick C Brennan; Mark F McEntee

doi:10.1016/j.breast.2016.10.003

Breast density (BD) assessment with digital breast tomosynthesis (DBT): Agreement between Quantra™ and 5th edition BI-RADS^®

Breast. 2016 Dec:30:185-190. doi: 10.1016/j.breast.2016.10.003. Epub 2016 Oct 19.

Authors

Ernest U Ekpo¹, Claudia Mello-Thoms², Mary Rickard³, Patrick C Brennan², Mark F McEntee²

Affiliations

¹ Discipline of Medical Radiation Sciences in the Faculty of Health Sciences and the Brain and Mind Center, The University of Sydney, Australia; Department of Radiography and Radiology, University of Calabar, PMB 1115, Calabar, Nigeria. Electronic address: eekp9437@uni.sydney.edu.au.
² Discipline of Medical Radiation Sciences in the Faculty of Health Sciences and the Brain and Mind Center, The University of Sydney, Australia.
³ Discipline of Medical Radiation Sciences in the Faculty of Health Sciences and the Brain and Mind Center, The University of Sydney, Australia; Sydney Breast Clinic, 97 - 99 Bathurst Street Sydney, NSW, 2000, Australia.

PMID: 27769015
DOI: 10.1016/j.breast.2016.10.003

Abstract

Purpose: To assess the agreement between digital breast tomosynthesis (DBT) breast density (BD) assessment made using Quantra™ and fifth edition BI-RADS^®.

Materials and methods: This board approved study involved BD assessment of 234 women undergoing DBT investigation. BD estimation was performed from the raw DBT images using Quantra™ 3 (v.2.1.1, Hologic, Bedford MA). BI-RADS^® assessment was performed using prior digital mammograms displayed simultaneously with 2D images synthesized from DBT by three radiologists using the fifth edition BI-RADS^® (A, B, C, D). Kappa (к) was used to assess inter-reader agreement, agreement between Quantra™ and each reader, as well as the majority report of all readers. Receiver Operating Characteristic (ROC) analysis was used to assess the performance of Quantra™ in reproducing the majority BI-RADS^® assessment. Data was then grouped into a two-category scale [almost entirely fatty and scattered fibroglandular tissue (A-B) versus heterogeneously dense and extremely dense (C-D)], and a further analysis performed.

Results: Inter-reader agreement varied from fair [0.38 (95%CI: 0.30-0.46)] to substantial [0.68 (95%CI: 0.61-0.75)] on a four-category scale and substantial [0.70 (95%CI: 0.61-0.78)] to almost perfect [0.85 (95%CI: 0.78-0.92)] on a two-category scale. Using the majority report, the agreement between BI-RADS^® and Quantra™ was 0.68 (95%CI: 0.59-0.75) on a four-category scale and 0.86 (95%CI: 0.79-0.93) on a two-category scale. Quantra™ distinguished BI-RADS^® A-B from C-D with 97.1% sensitivity and 83.1% specificity.

Conclusion: Data demonstrate moderate to substantial agreement in BD assessment between fifth edition BI-RADS^® and Quantra™.

Keywords: Dense tissue; Mammography; Measurement; ROC; Radiology; Two-category scale.

MeSH terms

Breast / diagnostic imaging*
Breast Density*
Female
Humans
Mammography*
Observer Variation
ROC Curve
Radiographic Image Interpretation, Computer-Assisted*