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Comparative Study
. 2019 Jan;29(1):330-336.
doi: 10.1007/s00330-018-5582-0. Epub 2018 Jun 25.

Comparison between software volumetric breast density estimates in breast tomosynthesis and digital mammography images in a large public screening cohort

Daniel Förnvik  1 , Hannie Förnvik  1 , Andreas Fieselmann  2 , Kristina Lång  1 , Hanna Sartor  3
Affiliations
Comparative Study

Comparison between software volumetric breast density estimates in breast tomosynthesis and digital mammography images in a large public screening cohort

Daniel Förnvik et al. Eur Radiol. 2019 Jan.

Abstract

Objectives: To compare software estimates of volumetric breast density (VBD) based on breast tomosynthesis (BT) projections to those based on digital mammography (DM) images in a large screening cohort, the Malmö Breast Tomosynthesis Screening Trial (MBTST).

Methods: DM and BT images of 9909 women (enrolled 2010-2015) were retrospectively analysed with prototype software to estimate VBD. Software calculation is based on a physics model of the image acquisition process and incorporates the effect of masking in DM based on accumulated dense tissue areas. VBD (continuously and categorically) was compared between BT [central projection (mediolateral oblique view (MLO)] and two-view DM, and with radiologists' BI-RADS density 4th ed. scores. Agreement and correlation were investigated with weighted kappa (κ), Spearman's correlation coefficient (r), and Bland-Altman analysis.

Results: There was a high correlation (r = 0.83) between VBD in DM and BT and substantial agreement between the software breast density categories [observed agreement, 61.3% and 84.8%; κ = 0.61 and ĸ = 0.69 for four (a/b/c/d) and two (fat involuted vs. dense) density categories, respectively]. There was moderate agreement between radiologists' BI-RADS scores and software density categories in DM (ĸ = 0.55) and BT (ĸ = 0.47).

Conclusions: In a large public screening setting, we report a substantial agreement between VBD in DM and BT using software with special focus on masking effect. This automated and objective mode of measuring VBD may be of value to radiologists and women when BT is used as the primary breast cancer screening modality.

Key points: • There was a high correlation between continuous volumetric breast density in DM and BT. • There was substantial agreement between software breast density categories (four groups) in DM and BT; with clinically warranted binary software breast density categories, the agreement increased markedly. • There was moderate agreement between radiologists' BI-RADS scores and software breast density categories in DM and BT.

Keywords: Breast neoplasms; Diagnostic imaging; Digital breast tomosynthesis; Mammography; Mass screening.

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Conflict of interest statement

Guarantor

The scientific guarantor of this publication is Hanna Sartor, MD PHD.

Conflict of interest

The authors of this manuscript declare relationships with the following companies:

Siemens Healthcare

Siemens has provided us with the mammography/tomosynthesis equipment and VBD software prototype. The sponsors (Siemens) of the study had no role in the design and performance of the study, data analyses, or data interpretation. One of the co-authors, AF PhD, Siemens Healthcare, has provided expertise on the software prototype. HS and KL have received speaker’s fees and travel grants for talking at Siemens seminars.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in:

1. Lang K, Andersson I, Rosso A, Tingberg A, Timberg P, Zackrisson S. Performance of one-view breast tomosynthesis as a stand-alone breast cancer screening modality: results from the Malmo Breast Tomosynthesis Screening Trial, a population-based study. European radiology. 2016;26(1):184–90.

2. Timberg P, Fieselmann A, Dustler M, Petersson H, Sartor H, Lång K, Zackrisson S. Breast density assessment using breast tomosynthesis images. In: Tingberg A, ed. International Workshop of Digital Mammography (IWDM) 2016. Switzerland: Springer International Publishing, 2016; p. 197–202.

3. Rosso A, Lang K, Petersson IF, Zackrisson S. Factors affecting recall rate and false positive fraction in breast cancer screening with breast tomosynthesis - A statistical approach. Breast. 2015;24(5):680–6.

4. Sartor H, Lang K, Rosso A, Borgquist S, Zackrisson S, Timberg P. Measuring mammographic density: comparing a fully automated volumetric assessment versus European radiologists’ qualitative classification. European radiology 2016;26:4354–4360.

5. Lang K, Nergarden M, Andersson I, Rosso A, Zackrisson S. False positives in breast cancer screening with one-view breast tomosynthesis: An analysis of findings leading to recall, work-up and biopsy rates in the Malmo Breast Tomosynthesis Screening Trial. European radiology. 2016;26(11):3899–907.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

Figures

Fig. 1
Fig. 1
Scatterplot illustrating correlation between software volumetric breast density (VBD) in DM and BT
Fig. 2
Fig. 2
Bland–Altman plot of volumetric breast density (VBD) measured by digital mammography (DM) subtracted from that measured by breast tomosynthesis (BT) compared with the mean of the two results. The middle dashed line is the mean difference and the top and bottom dashed lines are the 95% limits of agreement (±two standard deviations)
Fig. 3
Fig. 3
Scatterplot illustrating correlation between software volumetric breast density (VBD) in digital mammography (DM) and age
Fig. 4
Fig. 4
Scatterplot illustrating correlation between software volumetric breast density (VBD) in breast tomosynthesis (BT) and age
See this image and copyright information in PMC

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