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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
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.
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.
