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The purpose of this study was to compare visual assessments of mammographic breast density by radiologists using BI-RADS 4th and 5th editions in correlation with automated volumetric breast density measurements.A total of 337 consecutive full-field digital mammographic examinations with standard views were retrospectively assessed by two radiologists for mammographic breast density according to BI-RADS 4th and 5th editions. Fully automated measurement of the volume of fibroglandular tissue and total breast and percentage breast density was performed with a commercially available software program. Interobserver and intraobserver agreement was assessed with kappa statistics. The distributions of breast density categories for both editions of BI-RADS were compared and correlated with volumetric data.Interobserver agreement on breast density category was moderate to substantial (κ = 0.58-0.63) with use of BI-RADS 4th edition and substantial (κ = 0.63-0.66) with use of the 5th edition but without significant difference between the two editions. For intraobserver agreement between the two editions, the distributions of density category were significantly different (p0.0001), the proportions of dense breast increased, and the proportion of fatty breast decreased with use of the 5th edition compared with the 4th edition (p0.0001). All volumetric breast density data, including percentage breast density, were significantly different among density categories (p0.0001) and had significant correlation with visual assessment for both editions of BI-RADS (p0.01).Assessment using BI-RADS 5th edition revealed a higher proportion of dense breast than assessment using BI-RADS 4th edition. Nevertheless, automated volumetric density assessment had good correlation with visual assessment for both editions of BI-RADS.

The purpose of this study is to evaluate automated volumetric measurements in comparison with visual assessment of mammographic breast density by use of the fifth edition of BI-RADS.A total of 1185 full-field digital mammography examinations with standard views were retrospectively analyzed. All images were visually assessed by two blinded radiologists according to breast density category in the fifth edition of the BI-RADS lexicon. Automated volumetric breast density assessment was performed using two different software programs, Quantra and Volpara. A weighted kappa value was calculated to assess the degree of agreement among the visual and volumetric assessments of the density category. The volumes of fibroglandular tissue or total breast and the percentage breast density provided by the two software programs were compared.Compared with a visual assessment, the agreement of density category ranged from moderate to substantial in Quantra (κ = 0.54-0.61) and fair to moderate in Volpara (κ = 0.32-0.43). The distribution of density category was statistically significantly different among visual and volumetric measurements (p0.0001). Quantra assigned category A and B (43.5%) more frequently than did the radiologists (25.6%) or Volpara (16.0%). Volpara assigned category D (42.1%) more frequently than did the radiologists (19.5%) or Quantra (15.4%). Between the two software programs, the means of all volumetric data were statistically significantly different (p0.0001), but were well correlated (γ = 0.79-0.99; p0.0001).More mammographic examinations were classified as nondense breast tissue using the Quantra software and as dense breast tissue using the Volpara software, as compared with visual assessments according to the BI-RADS fifth edition.

The objective of our study was to estimate mammographic breast density using a fully automated volumetric breast density measurement method in comparison with BI-RADS breast density categories determined by radiologists.A total of 791 full-field digital mammography examinations with standard views were evaluated by three blinded radiologists as BI-RADS density categories 1-4. For fully automated volumetric analysis, volumetric breast density was calculated with fully automated software. The volume of fibroglandular tissue, the volume of the breast, and the volumetric percentage density were provided.The weighted overall kappa was 0.48 (moderate agreement) for the three radiologists' estimates of BI-RADS density. Pairwise comparisons of the radiologists' measurements of BI-RADS density revealed moderate to substantial agreement, with kappa values ranging from 0.51 to 0.64. There was a significant difference in mean volumetric breast density among the BI-RADS density categories, and the mean volumetric breast density increased as the BI-RADS density category increased (p0.001). A significant positive correlation was found between BI-RADS categories and fully automated volumetric breast density (ρ=0.765, p0.001).Our study showed good correlation of the fully automated volumetric method with radiologist-assigned BI-RADS density categories. Mammographic density assessment with the fully automated volumetric method may be used to assign BI-RADS density categories.