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Repeatability of breast density visual assessment

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Introduction

Breast density, measured as the proportion of the breast occupied by fibroglandular tissue in a mammogram, is a strong and modifiable risk factor for breast cancer. Area-based estimates made by expert observers are a practical approach, but are subjective. Here we investigate repeatability of visual assessment of percentage breast density.

Methods

Seven mammographic film readers re-assessed the density of 100 normal full-field digital mammogram cases for which they had made density estimates at least 1 year previously as part of the Predicting Risk of Cancer at Screening (PROCAS) study. The mammograms for a given reader were selected to show a range in density, by randomly sampling 10 cases from each decile of density assessed by that reader. They were reviewed in similar reading conditions on both occasions using a visual analogue scale to record the assessments.

Results

For the majority of readers the difference in mean density between the two sets of readings was less than 6%, but the largest discrepancy between means was 14.7%. Bland-Altman plots were generated for each reader and showed considerable variation between readings on the two occasions. At best, the limits of agreement were -12.46% to +17.02%, and at worst they were -14.50% to +40.98%. The largest difference between first and second readings for each reader ranged from 26 to 65%.

Conclusion

Although density estimates made by a subset of these readers have been strongly related to cancer risk, the variability in reproducibility calls into question the usefulness of subjective assessment without prior evaluation of reader performance.

Author information

Correspondence to L Walshaw.

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Walshaw, L., Sergeant, J., Wilson, M. et al. Repeatability of breast density visual assessment. Breast Cancer Res 14, P27 (2012) doi:10.1186/bcr3282

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Keywords

  • Breast Cancer
  • Visual Analogue Scale
  • Density Estimate
  • Visual Assessment
  • Breast Density