Breast arterial calcifications on mammography: intra- and inter-observer reproducibility of a semi-automatic quantification tool

Trimboli, Rubina Manuela; Codari, Marina; Bert, Alberto; Carbonaro, Luca A.; Maccagnoni, Sara; Raciti, Dario; Bernardi, Daniele; Clauser, Paola; Losio, Claudio; Tagliafico, Alberto; Sardanelli, Francesco

doi:10.1007/s11547-017-0827-6

Cited by 9 publications

(9 citation statements)

References 19 publications

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“…In fact, non-traditional risk factors unique or predominant to women have to be advocated for a sexspecific risk assessment, crucial for a better outcome. Efforts have been undertaken to improve the performance of traditional cardiovascular risk scores with the help of algorithms and imaging biomarkers (26).…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, agreement rates fell into the highest category according to the Landis and Koch classification (29) and this is reassuring. Experienced readers may possibly have a higher reproducibility, even if, differently from parenchymal calcifications deemed to be malignant, in this context, the human identification of BAC represents the main source of variability (26). Third, a "ground truth" for BAC was not applied.…”

Section: Discussionmentioning

confidence: 99%

“…Various strategies have been proposed to quantify BAC on a continuous or ordinal scale (20). Published studies range from manual estimation of BAC burden on both semiquantitative (11,(21)(22)(23) and continuous scales (24,25) to semiautomatic (26) and automatic segmentation algorithms (27,28). However, only few of these solutions have had their reproducibility tested and largely vary in robustness (21,22,25,26), thus reflecting the topological complexity of BAC as well as the absence of standardized criteria.…”

Section: Introductionmentioning

confidence: 99%

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Semiquantitative score of breast arterial calcifications on mammography (BAC-SS): intra- and inter-reader reproducibility

Trimboli¹,

Codari²,

Cozzi³

et al. 2021

Quant Imaging Med Surg

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Background: Breast arterial calcifications (BAC), representing Mönckeberg's sclerosis of the tunica media of breast arteries, are an imaging biomarker for cardiovascular risk stratification in the female population.Our aim was to estimate the intra-and inter-reader reproducibility of a semiquantitative score for BAC assessment (BAC-SS).Methods: Consecutive women who underwent screening mammography at our center from January 1 st to January 31 st , 2018 were retrieved and included according to BAC presence. Two readers (R1 and R2) independently applied the BAC-SS to medio-lateral oblique views, obtaining a BAC score by summing: (I) number of calcified vessels (from 0 to n); (II) vessel opacification, i.e., the degree of artery coverage by calcium bright pixels (0 or 1); and (III) length class of calcified vessels (from 0 to 4). R1 repeated the assessment 2 weeks later. Scoring time was recorded. Cohen's κ statistics and Bland-Altman analysis were used.Results: Among 408 women, 57 (14%) had BAC; 114 medio-lateral oblique views were assessed. Median BAC score was 4 [interquartile range (IQR): 3-6] for R1 and 4 (IQR: 2-6) for R2 (P=0.417) while median scoring time was 156 s (IQR: 99-314 s) for R1 and 191 s (IQR: 137-292 s) for R2 (P=0.743). Bland-Altman analysis showed a 77% intra-reader reproducibility [bias: 0.193, coefficient of repeatability (CoR): 0.955] and a 64% inter-reader reproducibility (bias: 0.211, CoR: 1.516). Cohen's κ for BAC presence was 0.968 for intra-reader agreement and 0.937 for inter-reader agreement.Conclusions: Our BAC-SS has a good intra-and inter-reader reproducibility, within acceptable scoring times. A large-scale study is warranted to test its ability to stratify cardiovascular risk in women.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Semiquantitative score of breast arterial calcifications on mammography (BAC-SS): intra- and inter-reader reproducibility

Trimboli¹,

Codari²,

Cozzi³

et al. 2021

Quant Imaging Med Surg

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“…The target population for a cost-effective further risk assessment is primarily represented by individuals at intermediate cardiovascular risk; indeed, in a low-risk population, the rationale for preventive intervention is missing, while in a high-risk population, further risk assessment would not reasonably impact on a formerly recommended pharmacological treatment [21]. Nevertheless, the major source of bias for qualitative or semi-quantitative methods for BAC evaluation has been-up to now-their poor reproducibility [7,22]. Albeit easily detectable on mammography, BAC topological complexity and vessel overlap on twodimensional mammographic projections make both the identification and quantification of BAC quite difficult to standardise, preventing robust validation and subsequent clinical application [5,7].…”

Section: Discussionmentioning

confidence: 99%

Breast arterial calcifications as a biomarker of cardiovascular risk: radiologists’ awareness, reporting, and action. A survey among the EUSOBI members

et al. 2020

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Objectives To investigate the knowledge of radiologists on breast arterial calcifications (BAC) and attitude about BAC reporting, communication to women, and subsequent action. Methods An online survey was offered to EUSOBI members, with 17 questions focused on demographics, level of experience, clinical setting, awareness of BAC association with cardiovascular risk, mammographic reporting, modality of BAC assessment, and action habits. Descriptive statistics were used. Results Among 1084 EUSOBI members, 378 (34.9%) responded to the survey, 361/378 (95.5%) radiologists, 263 females (69.6%), 112 males (29.6%), and 3 (0.8%) who did not specify their gender. Of 378 respondents, 305 (80.7%) declared to be aware of BAC meaning in terms of cardiovascular risk and 234 (61.9%) to routinely include BAC in mammogram reports, when detected. Excluding one inconsistent answer, simple annotation of BAC presence was declared by 151/233 (64.8%), distinction between low versus extensive BAC burden by 59/233 (25.3%), and usage of an ordinal scale by 22/233 (9.5%) and of a cardinal scale by 1/233 (0.4%). Among these 233 radiologists reporting BAC, 106 (45.5%) declared to orally inform the woman and, in case of severe BAC burden, 103 (44.2%) to investigate cardiovascular history, and 92 (39.5%) to refer the woman to a cardiologist. Conclusion Among EUSOBI respondents, over 80% declared to be aware of BAC cardiovascular meaning and over 60% to include BAC in the report. Qualitative BAC assessment predominates. About 40% of respondents who report on BAC, in the case of severe BAC burden, investigate cardiovascular history and/or refer the woman to a cardiologist. Key Points • Of 1084 EUSOBI members, 378 (35%) participated: 81% of respondents are aware of breast arterial calcification (BAC) cardiovascular meaning and 62% include BAC in the mammogram report. • Of those reporting BAC, description of presence was declared by 65%, low versus extensive burden distinction by 25%, usage of an ordinal scale by 10%, and of a cardinal scale by 0.4%; 46% inform the woman and, in case of severe BAC burden, 44% examine cardiovascular history, and 40% refer her to a cardiologist. Rubina Manuela Trimboli and Davide Capra equally contributed to this work and share co-first authorship.

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“…Breast cancer is the most common cancer among women in the world (1)(2)(3)(4)(5). The main causes of cancerrelated death are invasion and metastases.…”

Section: Introductionmentioning

confidence: 99%

Apparent diffusion coefficient magnetic resonance imaging (ADC-MRI) in the axillary breast cancer lymph node metastasis detection: a narrative review

et al. 2020

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The presence of axillary lymph nodes metastases in breast cancer is the most significant prognostic factor, with a great impact on morbidity, disease-related survival and management of oncological therapies; for this reason, adequate imaging evaluation is strictly necessary. Physical examination is not enough sensitive to assess breast cancer nodal status; axillary ultrasonography (US) is commonly used to detect suspected or occult nodal metastasis, providing exclusively morphological evaluation, with low sensitivity and positive predictive value. Currently, sentinel lymph node biopsy (SLNB) and/or axillary dissection are the milestone for the diagnostic assessment of axillary lymph node metastases, although its related morbidity. The impact of magnetic resonance imaging (MRI) in the detection of nodal metastases has been widely investigated, as it continues to represent the most promising imaging modality in the breast cancer management. In particular, diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) values represent additional reliable non-contrast sequences, able to improve the diagnostic accuracy of breast cancer MRI evaluation. Several studies largely demonstrated the usefulness of implementing DWI/ADC MRI in the characterization of breast lesions. Herein, in the light of our clinical experience, we perform a review of the literature regarding the diagnostic performance and accuracy of ADC value as potential pre-operative tool to define metastatic involvement of nodal structures in breast cancer patients.

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Breast arterial calcifications on mammography: intra- and inter-observer reproducibility of a semi-automatic quantification tool

Abstract: Our semi-automatic tool for BAC quantification showed a poor reproducibility. These results pointed out that the human identification of BAC represents the main source of variability. Further research is needed to translate BAC quantification into clinical practice.

Cited by 9 publications

References 19 publications

Semiquantitative score of breast arterial calcifications on mammography (BAC-SS): intra- and inter-reader reproducibility

Semiquantitative score of breast arterial calcifications on mammography (BAC-SS): intra- and inter-reader reproducibility

Breast arterial calcifications as a biomarker of cardiovascular risk: radiologists’ awareness, reporting, and action. A survey among the EUSOBI members

Apparent diffusion coefficient magnetic resonance imaging (ADC-MRI) in the axillary breast cancer lymph node metastasis detection: a narrative review

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