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. 2020 May 21;10(5):331.
doi: 10.3390/diagnostics10050331.

Subjective Versus Quantitative Methods of Assessing Breast Density

Wijdan Alomaim  1 , Desiree O'Leary  2 , John Ryan  3 , Louise Rainford  3 , Michael Evanoff  4 , Shane Foley  3
Affiliations

Subjective Versus Quantitative Methods of Assessing Breast Density

Wijdan Alomaim et al. Diagnostics (Basel). .

Abstract

In order to find a consistent, simple and time-efficient method of assessing mammographic breast density (MBD), different methods of assessing density comparing subjective, quantitative, semi-subjective and semi-quantitative methods were investigated. Subjective MBD of anonymized mammographic cases (n = 250) from a national breast-screening programme was rated by 49 radiologists from two countries (UK and USA) who were voluntarily recruited. Quantitatively, three measurement methods, namely VOLPARA, Hand Delineation (HD) and ImageJ (IJ) were used to calculate breast density using the same set of cases, however, for VOLPARA only mammographic cases (n = 122) with full raw digital data were included. The agreement level between methods was analysed using weighted kappa test. Agreement between UK and USA radiologists and VOLPARA varied from moderate (κw = 0.589) to substantial (κw = 0.639), respectively. The levels of agreement between USA, UK radiologists, VOLPARA with IJ were substantial (κw = 0.752, 0.768, 0.603), and with HD the levels of agreement varied from moderate to substantial (κw = 0.632, 0.680, 0.597), respectively. This study found that there is variability between subjective and objective MBD assessment methods, internationally. These results will add to the evidence base, emphasising the need for consistent, simple and time-efficient MBD assessment methods. Additionally, the quickest method to assess density is the subjective assessment, followed by VOLPARA, which is compatible with a busy clinical setting. Moreover, the use of a more limited two-scale system improves agreement levels and could help minimise any potential country bias.

Keywords: American College of Radiology Breast Imaging Reporting and Data System; BI-RADS; ImageJ; VOLPARA; automated volumetric breast density measurement; breast density; breast imaging; mammographic breast density; quantitative density assessment.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(a). Screen shot of the semi-subjective (HD) method showing the craniocaudal and mediolateral oblique breast images with boundaries drawn around the outer surface of the breast. (b). Screen shot of the semi-subjective (HD) software showing the craniocaudal and mediolateral oblique breast images with boundaries drawn around the fibroglandular tissue within the breast.
Figure 2
Figure 2
Screenshot of the semi-objective (ImageJ) software, showing a right Cranio-Caudal image with the density as highlighted and the red circle represents the volume density percentage by the software.
Figure 3
Figure 3
Screen shot of an example of the automated objective density assessment (VOLPARA) software; the red circle shows the BI-RADS as graded by the software.
Figure 4
Figure 4
Percentage of the distractors within total cases according to the number of reads, as decided by the UK radiologists.
Figure 5
Figure 5
Distribution of the BI-RADS scoring amongst cases with and without distractors for VOLPARA and UK radiologists.
See this image and copyright information in PMC

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