From the Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3710 Hamilton Walk, Room G601E Goddard Building, Philadelphia, PA 19104 (A.G., L.P., M.S., D.K., E.F.C.); and Department of Medicine, Massachusetts General Hospital, Boston, Mass (A.M.M.).
Radiology. 2019 May;291(2):320-327. doi: 10.1148/radiol.2019181740. Epub 2019 Mar 19.
Background Breast Imaging Reporting and Data System (BI-RADS) breast density categories assigned by interpreting radiologists often influence decisions surrounding supplemental breast cancer screening and risk assessment. The landscape of mammographic screening continuously evolves, and different mammographic screening modalities may result in different perception of density, reflected in different assignment of BI-RADS density categories. Purpose To investigate the effect of screening mammography modality on BI-RADS breast density assessments. Materials and Methods Data were retrospectively analyzed from 24 736 individual women (42.3% [10 455 of 24 736] white women, 57.7% [14 281 of 24 736] black women; mean age, 56.3 years; age range, 40.0-74.9 years) who underwent from one to seven mammographic screening examinations from September 2010 through February 2017 (60 766 examinations). Three screening modalities were used: digital mammography alone (8935 examinations); digital mammography with digital breast tomosynthesis (DBT; 30 779 examinations); and synthetic mammography with DBT (21 052 examinations). Random-effects logistic regression analysis was performed to estimate the likelihood of assignment to high versus low BI-RADS density category according to each modality, adjusted for ethnicity, age, body mass index (BMI), and radiologist. The interactions of modality with ethnicity and BMI on density categorization were also tested with the model. Results Women screened with DBT versus digital mammography alone had lower likelihood regarding categorization of high density breasts (digital mammography and DBT vs digital mammography: odds ratio, 0.69 [95% confidence interval: 0.61, 0.80], < .001; synthetic mammography and DBT vs digital mammography: odds ratio, 0.43 [95% confidence interval: 0.37, 0.50], < .001). Lower likelihood of high density was also observed at synthetic mammography and DBT compared with digital mammography and DBT (odds ratio, 0.62; 95% confidence interval: 0.56, 0.69; < .001). There were interactions of modality with ethnicity ( = .007) and BMI ( = .003) on breast density assessment, with greater differences in density categorization according to modality observed for black women than for white women and groups with higher BMI. Conclusion Breast density categorization may vary by screening mammographic modality, and this effect appears to vary by ethnicity and body mass index. © RSNA, 2019 See also the editorial by Philpotts in this issue.
背景 乳腺影像报告和数据系统 (BI-RADS) 由影像科医生进行的乳腺密度分类，常影响辅助乳腺癌筛查和风险评估的决策。乳腺筛查的方式不断演变，不同的乳腺筛查方式可能导致对密度的不同感知，反映在 BI-RADS 密度分类的不同分配上。目的 探讨乳腺筛查方式对 BI-RADS 乳腺密度评估的影响。材料与方法 回顾性分析了 24736 名女性（42.3%[10455 名/24736 名]白人女性，57.7%[14281 名/24736 名]黑人女性；平均年龄 56.3 岁；年龄范围 40.0-74.9 岁）的数据，这些女性在 2010 年 9 月至 2017 年 2 月期间接受了 1 至 7 次乳腺筛查检查（共 60766 次检查）。使用了 3 种筛查方式：单纯数字化乳腺 X 线摄影术（8935 次检查）；数字化乳腺 X 线摄影术联合数字乳腺断层合成术（30779 次检查）；合成数字化乳腺 X 线摄影术联合数字乳腺断层合成术（21052 次检查）。采用随机效应逻辑回归分析，根据每种方式，调整了种族、年龄、体重指数（BMI）和放射科医生的影响，以评估高与低 BI-RADS 密度类别分配的可能性。还使用模型测试了方式与种族和 BMI 对密度分类的相互作用。结果 与单纯数字化乳腺 X 线摄影术相比，接受数字乳腺断层合成术检查的女性中，高乳腺密度分类的可能性较低（单纯数字化乳腺 X 线摄影术与数字乳腺断层合成术：比值比，0.69[95%置信区间：0.61，0.80]， <.001；合成数字化乳腺 X 线摄影术与数字乳腺断层合成术：比值比，0.43[95%置信区间：0.37，0.50]， <.001）。与单纯数字化乳腺 X 线摄影术与数字乳腺断层合成术相比，在合成数字化乳腺 X 线摄影术与数字乳腺断层合成术检查中也观察到高乳腺密度的可能性较低（比值比，0.62；95%置信区间：0.56，0.69； <.001）。在种族（ =.007）和 BMI（ =.003）方面，方式与乳腺密度评估存在交互作用，黑人女性与白人女性以及 BMI 较高的女性之间，根据方式观察到的密度分类差异更大。结论 乳腺密度分类可能因乳腺筛查方式而异，这种影响似乎因种族和 BMI 而异。
