From the Division of General Internal Medicine, Department of Medicine (J.A.T.), and Department of Radiology and Biomedical Imaging (B.N.J.), University of California, San Francisco, 1545 Divisadero St, Suite 309, San Francisco, CA 94143-0320; General Internal Medicine Section, Department of Veterans Affairs and Departments of Medicine and Epidemiology and Biostatistics, San Francisco, Calif (K.K.); Department of Economics, Applied Statistics, and International Business, New Mexico State University, Las Cruces, NM (C.C.G.); Department of Public Health Sciences, University of California, Davis, School of Medicine, Davis, Calif (D.L.M., T.Q.H.H.); Kaiser Permanente Washington Health Research Institute, Seattle, Wash (D.L.M.); Department of Surgery, University of Vermont, Burlington, Vt (B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); and Department of Training and Scientific Research, University Medical Center, Ho Chi Minh City, Vietnam (T.Q.H.H.).
Radiology. 2022 Feb;302(2):286-292. doi: 10.1148/radiol.2021204579. Epub 2021 Nov 23.
Background Consistency in reporting Breast Imaging Reporting and Data System (BI-RADS) breast density on mammograms is important because breast density is used for breast cancer risk assessment and is reported directly to women and clinicians to inform decisions about supplemental screening. Purpose To assess the consistency of BI-RADS density reporting between digital breast tomosynthesis (DBT) and digital mammography (DM) and evaluate density as a breast cancer risk factor when assessed using DM versus DBT. Materials and Methods The Breast Cancer Surveillance Consortium is a prospective cohort study of women undergoing mammography with DM or DBT. This secondary analysis included women aged 40-79 years who underwent at least two screening mammography examinations less than 36 months apart. Percentage agreement and κ statistic were estimated for pairs of BI-RADS density assessments. Cox proportional hazards regression was used to calculate hazard ratios (HRs) of breast density as a risk factor for invasive breast cancer. Results A total of 403 326 pairs of mammograms from 342 149 women were evaluated. There were no significant differences in breast density assessment in pairs consisting of one DM and one DBT examination (57 516 of 74 729 [77%]; κ = 0.64), two DM examinations (238 678 of 301 743 [79%]; κ = 0.67), and two DBT examinations (20 763 of 26 854 [77%]; κ = 0.65). Results were similar when restricting the analyses to pairs read by the same radiologist. The breast cancer HRs for breast density were similar for DM and DBT ( = .45 for interaction). The HRs for density acquired using DM and DBT, respectively, were 0.55 (95% CI: 0.49, 0.63) and 0.37 (95% CI: 0.21, 0.66) for almost entirely fat, 1.47 (95% CI: 1.37, 1.58) and 1.36 (95% CI: 1.02, 1.82) for heterogeneously dense, and 1.72 (95% CI: 1.54, 1.93) and 2.05 (95% CI: 1.25, 3.36) for extremely dense breasts. Conclusion Radiologist reporting of Breast Imaging Reporting and Data System density obtained with digital breast tomosynthesis did not differ from that obtained with digital mammography. © RSNA, 2021
背景 乳腺成像报告和数据系统 (BI-RADS) 乳腺密度的报告一致性很重要，因为乳腺密度用于乳腺癌风险评估，并直接向女性和临床医生报告，以告知关于补充筛查的决策。目的 评估数字乳腺断层合成术 (DBT) 和数字乳腺摄影术 (DM) 之间 BI-RADS 密度报告的一致性，并评估使用 DM 与 DBT 评估时密度作为乳腺癌风险因素的情况。材料与方法 乳腺癌监测联盟是一项对接受 DM 或 DBT 筛查性乳房 X 线摄影的女性进行的前瞻性队列研究。这项二次分析包括年龄在 40-79 岁之间、在不到 36 个月的时间内接受至少两次筛查性乳房 X 线摄影检查的女性。对 BI-RADS 密度评估的每对评估进行百分比一致性和 κ 统计评估。使用 Cox 比例风险回归计算作为乳腺癌风险因素的乳腺密度的危险比 (HR)。结果 在 342149 名女性中，共评估了 403326 对乳房 X 线摄影。由 1 次 DM 和 1 次 DBT 检查组成的对 (74729 例中的 57516 例 [77%]；κ=0.64)、2 次 DM 检查 (301743 例中的 238678 例 [79%]；κ=0.67)和 2 次 DBT 检查 (26854 例中的 20763 例 [77%]；κ=0.65)，其密度评估没有显著差异。当限制分析为由同一位放射科医生阅读的对时，结果相似。DM 和 DBT 的乳腺癌 HR 相似(交互作用 =.45)。分别使用 DM 和 DBT 获取的密度的 HR 分别为 0.55 (95%CI：0.49，0.63)和 0.37 (95%CI：0.21，0.66)用于几乎全是脂肪，1.47 (95%CI：1.37，1.58)和 1.36 (95%CI：1.02，1.82)用于异质致密，1.72 (95%CI：1.54，1.93)和 2.05 (95%CI：1.25，3.36)用于极度致密的乳房。结论 数字乳腺断层合成术获得的乳腺成像报告和数据系统密度的放射科报告与数字乳腺摄影术获得的报告没有差异。
