Comparative estimation of percentage breast tissue density for digital mammography, digital breast tomosynthesis, and magnetic resonance imaging

Abstract

Given the increasingly important role of breast density as an independent risk factor for breast cancer, and the variable breast imaging tests that potentially provide measures for density. We compared breast tissue density on digital mammography (FFDM), digital breast tomosynthesis (DBT), and magnetic resonance imaging (MRI) using semi-automated automated software. These three imaging modalities have not been previously directly compared for estimating breast tissue density. Following informed consent from all participating women, FFDM, DBT, and MRI were performed. Breast percentage density was calculated with semi-automated software, and compared, for all three imaging modalities. 48 patients (mean age, 41 years; range, 35-67 years) underwent FFDM, DBT, and MRI. Percent FFDM, DBT, and MRI breast density measures showed a positive linear correlation, (r = 0.95 for MRI and DBT, P < 0.0001; r = 0.97, P < 0.0001 for FFDM and DBT; r = 0.87 for FFDM and MRI). Linear regression analysis related to MRI and DBT had a high r (2) = 0.89 (95 % CI = 0.88-0.99, P < 0.001). FFDM overestimated breast density in 15.1 % in comparison to DBT and in 16.2 % in comparison to MRI, or conversely each of DBT and MRI underestimated density (relative to FFDM) by 15.1 or 16.2 %, respectively. Differences in percentage breast density between FFDM and DBT, and between FFDM and MRI, were highly significant (P < 0.0001). Differences in percentage breast density between DBT and MRI were not significant (P > 0.05). Breast density measures using FFDM, DBT, or MRI were generally well-correlated, although differences were noted between estimates when comparing FFDM and DBT, and for estimates comparing FFDM and MRI. No signficant differences in percentage density were observed when comparing DBT and MRI. Our work highlight that differences between FFDM, DBT, and MRI should be considered when measuring percentage breast density.

Breast composition: Measurement and clinical use

“…[103][104][105][106] Image J has demonstrated strong correlation with Cumulus and BIRADS 107 and positive association between breast density and cancer risk. 28,108 However, quantum and anatomical noise reduce the reliability of AutoDensity and MedDensity.…”

Differences in breast density assessment using mammography, tomosynthesis and MRI and their implications for practice

“…To evaluate breast density on mammograms quantitatively, it is possible to use either film-screen or full-field digital mammograms [11,13,16]. As visual assessment is invariably subjective and associated with suboptimal reproducibility, its replacement with reproducible computerised density assessment has been suggested [5][6][7][8][9][10][11].…”

“…To date (and to the best of our knowledge), only one study directly compared breast tissue density estimates evaluated on digital mammograms with DBT and on MRI within the same patients [11]. In this study, the MRI sequence used as a reference standard was an iterative decomposition of water and fat with echo asymmetry and least squares estimation (IDEAL) sequence.…”

“…These commonly used imaging techniques may give similar results for density assessment, but they may not always be interchangeable for an individualised purpose [11]. Therefore, the purpose of this article is to give a brief overview on breast density percentage assessment with these imaging techniques, highlighting our perspectives on the differences and limitations of each technique.…”

Volumetric breast density measurement: sensitivity analysis of a relative physics approach

“…[33][34][35][36][37] Examples of automated VBD measurement systems which are available commercially include Quantra (Hologic, Bedford, MA) and Volpara® (Matakina Technology Ltd, Wellington, New Zealand). From previous studies, it appears 10 and Volpara 18 appears to be a further implementation of that original work along with ideas from van Engeland et al 24 Results vs breast MRI appear to suggest that volumetric techniques are now approaching clinical utility, [39][40][41][42] but no thorough sensitivity and robustness analyses appear to have been carried out, to the best of our knowledge, except the one reported by Volpara developers during its early stage of development. 18 Owing to the widespread use of breast density and recent legislative activities in the USA where the laws require females to be informed about their breast density in the mammographic report, it is important that breast density measurement tools are able to provide accurate, consistent and reliable results.…”