Inter country analysis of breast density classification using visual grading. Analysis of mammographic breast density using visual grading

Damases, C; Hogg, P; McEntee, M

Abstract

Purpose: Disagreement in mammographic breast density (MBD) assessment can impact breast cancer risk stratification, choices of further breast cancer screening intervals and pathways. This study examines whether inter-country MBD expectations and assessment approaches are associated with differences in MBD assessment.
Methods: Twenty American Board of Radiology (ABR) examiners and 24 United Kingdom (UK) practitioners using the 4th edition BI-RADS® lexicon assessed 40 mammogram cases of 20 women. Twenty-six Royal Australian and New Zealand College of Radiologists (RANZCR) registered radiologists also assessed the same cases. Inter-observer correlation and agreement were assessed using a Spearman’s correlation (ρ) and weighted Kappa (Kw) respectively.
Results: Strong positive correlation was observed between the study cohorts on a binary scale (1–2 vs. 3–4) [ABR examiners and RANZCR radiologists (ρ = 0.950); ABR examiners and UK practitioners (ρ = 0.940); RANZCR radiologists and UK practitioners (ρ = 0.958)]. ABR and RANZCR radiologists demonstrated slight agreement [Kw = 0.10; 95% CI = -1.13 - 0.43] while ABR and UK practitioners showed a fair agreement [Kw = 0.25; 95% CI = -0.42 - 0.61], and an almost perfect agreement was observed between RANZCR radiologists and UK practitioners [Kw = 0.95; 95% CI = 0.91 - 0.97].
Conclusion: Findings demonstrate wide international and inter-observer variability in MBD assessment. This level of variability underscores the need for automation and standardisation of MBD assessment.
Keywords: Breast density, inter-observer agreement, visual assessment methods.

Citation

Damases, C., Hogg, P., & McEntee, M. (2017). Inter country analysis of breast density classification using visual grading. Analysis of mammographic breast density using visual grading. British Journal of Radiology, 90(1076), https://doi.org/10.1259/bjr.20170064

• Journal Article Type: Article
• Acceptance Date: Jun 6, 2017
• Online Publication Date: Jun 14, 2017
• Publication Date: Jun 14, 2017
• Deposit Date: Jun 9, 2017
• Publicly Available Date: Jun 14, 2018
• Journal: British Journal of Radiology
• Print ISSN: 0007-1285
• Electronic ISSN: 1748-880X
• Publisher: British Institute of Radiology
• Volume: 90
• Issue: 1076
• DOI: https://doi.org/10.1259/bjr.20170064
• Publisher URL: http://dx.doi.org/10.1259/bjr.20170064
• Related Public URLs: http://www.birpublications.org/toc/bjr/current