Youk Ji Hyun, Kim So Jung, Son Eun Ju, Gweon Hye Mi, Kim Jeong-Ah
1 Department of Radiology, Yonsei University College of Medicine, Gangnam Severance Hospital, 211, Eonju-ro, Gangnam-Gu, Seoul 06273, South Korea.
AJR Am J Roentgenol. 2017 Sep;209(3):703-708. doi: 10.2214/AJR.16.17525. Epub 2017 Jun 28.
The purpose of this study was to compare visual assessments of mammographic breast density by radiologists using BI-RADS 4th and 5th editions in correlation with automated volumetric breast density measurements.
A total of 337 consecutive full-field digital mammographic examinations with standard views were retrospectively assessed by two radiologists for mammographic breast density according to BI-RADS 4th and 5th editions. Fully automated measurement of the volume of fibroglandular tissue and total breast and percentage breast density was performed with a commercially available software program. Interobserver and intraobserver agreement was assessed with kappa statistics. The distributions of breast density categories for both editions of BI-RADS were compared and correlated with volumetric data.
Interobserver agreement on breast density category was moderate to substantial (κ = 0.58-0.63) with use of BI-RADS 4th edition and substantial (κ = 0.63-0.66) with use of the 5th edition but without significant difference between the two editions. For intraobserver agreement between the two editions, the distributions of density category were significantly different (p < 0.0001), the proportions of dense breast increased, and the proportion of fatty breast decreased with use of the 5th edition compared with the 4th edition (p < 0.0001). All volumetric breast density data, including percentage breast density, were significantly different among density categories (p < 0.0001) and had significant correlation with visual assessment for both editions of BI-RADS (p < 0.01).
Assessment using BI-RADS 5th edition revealed a higher proportion of dense breast than assessment using BI-RADS 4th edition. Nevertheless, automated volumetric density assessment had good correlation with visual assessment for both editions of BI-RADS.
本研究旨在比较放射科医生使用BI-RADS第4版和第5版对乳腺钼靶密度进行的视觉评估，并与自动体积乳腺密度测量结果进行相关性分析。
两位放射科医生根据BI-RADS第4版和第5版，对337例连续的有标准视图的全视野数字化乳腺钼靶检查进行回顾性评估，以确定乳腺钼靶密度。使用商用软件程序对纤维腺体组织体积、全乳体积和乳腺密度百分比进行全自动测量。采用kappa统计量评估观察者间和观察者内的一致性。比较BI-RADS两个版本的乳腺密度类别分布，并与体积数据进行相关性分析。
使用BI-RADS第4版时，观察者间对乳腺密度类别的一致性为中等至高度（κ = 0.58 - 0.63），使用第5版时为高度（κ = 0.63 - 0.66），但两个版本之间无显著差异。对于两个版本之间的观察者内一致性，密度类别的分布存在显著差异（p < 0.0001），与第4版相比，使用第5版时致密型乳腺的比例增加，脂肪型乳腺的比例降低（p < 0.0001）。所有体积乳腺密度数据，包括乳腺密度百分比，在密度类别之间均有显著差异（p < 0.0001），并且与BI-RADS两个版本的视觉评估均有显著相关性（p < 0.01）。
与使用BI-RADS第4版进行的评估相比，使用BI-RADS第5版进行的评估显示致密型乳腺的比例更高。然而，对于BI-RADS的两个版本，自动体积密度评估与视觉评估均具有良好的相关性。
