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Persistent inter-observer variability of breast density assessment using BI-RADS® 5th edition guidelines.

Leah H Portnow1, Dianne Georgian-Smith1, Irfanullah Haider1

  • 1Brigham and Women's Hospital, Department of Radiology, 75 Francis Street, Boston, MA 02115, United States of America.

Clinical Imaging
|December 24, 2021
PubMed
Summary

The 5th edition of Breast Imaging Reporting and Data System (BI-RADS) guidelines did not improve reader agreement on mammographic density assessment compared to the 4th edition. Experience level also did not significantly impact agreement, highlighting persistent subjectivity in density categorization.

Keywords:
AlgorithmsBreast densityComputing methodologiesMammography

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Area of Science:

  • Radiology
  • Medical Imaging
  • Breast Health

Background:

  • Mammographic density assessment is crucial for breast cancer risk stratification and screening recommendations.
  • Subjectivity in visual assessment based on Breast Imaging Reporting and Data System (BI-RADS) guidelines can impact clinical decisions.
  • Updates to BI-RADS guidelines aim to standardize mammographic density categorization.

Purpose of the Study:

  • To evaluate the impact of BI-RADS 5th edition (5th-ed) versus 4th edition (4th-ed) guidelines on inter-reader agreement for mammographic density assessment.
  • To compare density distribution and agreement between visual and quantitative assessments under both guideline versions.
  • To assess the influence of reader experience on mammographic density categorization agreement.

Main Methods:

  • Retrospective review of 200 screening mammograms assessed by experienced breast imaging radiologists (BIR) using 5th-ed guidelines.
  • Comparison with the same readers' assessments using 4th-ed guidelines from a previous study.
  • Analysis included inter-reader and intra-reader agreement using kappa statistics and comparison with quantitative density measurements (Volpara).

Main Results:

  • Inter-reader agreement for mammographic density was moderately strong (κw=0.73) with 5th-ed, similar to 4th-ed (κw=0.71).
  • The 5th-ed resulted in a higher proportion of dense categorizations (categories B/C) compared to the 4th-ed (p < 0.001).
  • Agreement between visual and quantitative assessments was comparable across both editions, and reader experience did not significantly affect density distribution agreement.

Conclusions:

  • The BI-RADS 5th-ed guidelines do not significantly improve inter-reader agreement in mammographic density assessment, indicating persistent subjectivity.
  • Reader experience does not correlate with improved agreement in mammographic density categorization.
  • Further standardization methods may be needed to enhance consistency in mammographic density assessment.