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Variability of Breast Density Classification Between US and UK Radiologists
Wijdan Alomaim1, Desiree O'Leary2, John Ryan1
1Radiography & Diagnostic Imaging, School of Medicine, University College Dublin, Ireland.
Journal of Medical Imaging and Radiation Sciences
|February 20, 2019
Summary
Radiologists in the US and UK show variations in subjective breast density assessment using BI-RADS categories. A two-scale method improved agreement, highlighting the need for standardized, automated breast density assessment for better screening.
Area of Science:
- Radiology
- Medical Imaging
- Breast Health
Background:
- Subjective breast density categorization is standard but may lack consistency.
- Geographic variations in national legislation could influence interpretation.
- Accurate breast density assessment is crucial for individualized screening.
Purpose of the Study:
- To evaluate if subjective breast density categorization is optimal.
- To identify geographic variations in mammographic breast density assessment.
- To compare breast density categorization between UK and US radiologists.
Main Methods:
- 250 anonymized mammograms were reviewed by UK and US radiologists.
- Subjective breast density was rated using Breast Imaging Reporting and Data System (BI-RADS) categories.
- Inter-rater reliability was assessed using the Kappa test.
Main Results:
- US radiologists classified fewer images as 'mostly fatty' compared to UK radiologists.
- Higher BI-RADS categories were assigned more frequently by US radiologists.
- Substantial overall agreement (k=0.654) was observed, but agreement varied by BI-RADS category.
Conclusions:
- Significant variations exist in subjective breast density classification between US and UK radiologists.
- A two-scale categorization method (low, high) demonstrated improved inter-rater agreement.
- Standardized and automated breast density assessment is recommended to enhance screening accuracy.
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