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International Interobserver Variability of Breast Density Assessment.

Leah H Portnow1, Lina Choridah2, Kardinah Kardinah3

  • 1Division of Breast Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts; and Instructor, Department of Radiology, Harvard Medical School, Boston, Massachusetts.

Journal of the American College of Radiology : JACR
|May 1, 2023
PubMed
Summary
This summary is machine-generated.

Radiologists worldwide show high agreement in breast density assessment using BI-RADS categories. However, significant variability exists in the distribution of density categories across different global locations.

Keywords:
Breast densityglobal radiologymammography

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Area of Science:

  • Radiology
  • Medical Imaging
  • Oncology

Background:

  • Mammographic breast density is a key factor in breast cancer risk assessment.
  • Standardized categorization of breast density is crucial for consistent interpretation and risk stratification.

Purpose of the Study:

  • To evaluate interreader agreement and variability in mammographic breast density categorization among radiologists globally.
  • To assess consistency in applying the BI-RADS density classification system across different countries.

Main Methods:

  • Retrospective review of 800 2-D digital screening mammograms from Indonesia, the Netherlands, South Africa, and the US.
  • Consensus density assessments by three radiologists per location using BI-RADS categories.
  • Statistical analysis including Gwet's AC2, AC1, Stuart-Maxwell, McNemar tests, and conditional logistic regression.

Main Results:

  • High interreader agreement (AC2=0.86) for four density categories and substantial agreement (AC1=0.66) for binary dense vs. not dense categories.
  • Statistically significant differences (P < .001) in density distribution across the four categories among different reader teams.
  • Majority of mammograms were categorized as scattered or heterogeneous density by all readers.

Conclusions:

  • While radiologists achieve high interreader agreement in BI-RADS density categorization, statistically significant variability in density distribution persists across global locations.
  • This variability highlights the need for further standardization or training to ensure consistent application of breast density assessments worldwide.