Sensitivity of screening mammography by density and texture: a cohort study from a population-based screening program in Denmark

Abstract

Background Screening mammography works better in fatty than in dense breast tissue. Computerized assessment of parenchymal texture is a non-subjective method to obtain a refined description of breast tissue, potentially valuable in addition to breast density scoring for the identification of women in need of supplementary imaging. We studied the sensitivity of screening mammography by a combination of radiologist-assessed Breast Imaging Reporting and Data System (BI-RADS) density score and computer-assessed parenchymal texture marker, mammography texture resemblance (MTR), in a population-based screening program. Methods Breast density was coded according to the fourth edition of the BI-RADS density code, and MTR marker was divided into quartiles from 1 to 4. Screening data were followed up for the identification of screen-detected and interval cancers. We calculated sensitivity and specificity with 95% confidence intervals (CI) by BI-RADS density score, MTR marker, and combination hereof. Results Density and texture were strongly correlated, but the combination led to the identification of subgroups with different sensitivity. Sensitivity was high, about 80%, in women with BI-RADS density score 1 and MTR markers 1 or 2. Sensitivity was low, 67%, in women with BI-RADS density score 2 and MTR marker 4. For women with BI-RADS density scores 3 and 4, the already low sensitivity was further decreased for women with MTR marker 4. Specificity was 97–99% in all subgroups. Conclusion Our study showed that women with low density constituted a heterogenous group. Classifying women for extra imaging based on density only might be a too crude approach. Screening sensitivity was systematically high in women with fatty and homogenous breast tissue.

Comparative study between contrast-enhanced mammography, tomosynthesis, and breast ultrasound as complementary techniques to mammography in dense breast parenchyma

“…The calculated diagnostic indices in our study did not completely match those reported in a cohort study performed by Von Euler-Chelpin et al [17] on 54,997 participants. In this study, they compared the sensitivity and specificity of mammography as compared to breast density.…”

Average glandular dose in paired digital mammography and digital breast tomosynthesis acquisitions in a population based screening program: effects of measuring breast density, air kerma and beam quality

“…Estimates of program sensitivities range from 75 -100 % for women with non-dense breasts, 69 -82 % for women with heterogeneously dense breasts, and 47 -84 % for women with extremely dense breasts (3,137,139,140). A similar trend has also been shown using Volpara TM for density stratification (141).…”

Breast cancer mortality and overdiagnosis after implementation of population-based screening in Denmark

“…In considering personalized screening, it should, however, be taken into account that the screening test itself is probably the best available tool to discriminate between high and low risk women. In the present nationwide Danish screening program with its "one-size-fits-all" biennial screening of women aged 50-69 years, the 2-year risk of breast cancer was 80 times higher in screen-positive than in screen-negative women [44]. In comparison, the ability of personalized screening models to discriminate between low and high risk women is 0.51-0.80, which is between none and moderate [45].…”