Alomaim, W, O'Leary, DS, Ryan, J, Rainford, L, Evanoff, M and Foley, S (2019) Variability of breast density classification between US and UK radiologists. Journal of Medical Imaging and Radiation Sciences, 50 (1). pp. 53-61.

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Abstract

Purpose
To assess whether subjective breast density categorization remains the most useful way to categorize mammographic breast density and whether variations exist across geographic regions with differing national legislation.

Methods
Breast radiologists from two countries (UK, USA) were voluntarily recruited to review sets of anonymized mammographic images (n = 180) and additional repeated images (n = 70), totaling 250 images, to subjectively rate breast density according to the Breast Imaging Reporting and Data system (BI-RADS) categorization. Images were reviewed using standardized viewing conditions and Ziltron software. Inter-rater reliability was analyzed using the Kappa test.

Results
The US radiologists (n = 25) judged fewer images as being “mostly fatty” than UK radiologists (n = 24), leading a greater number of images classified in the higher BI-RADS categories, particularly in BI-RADS 3. Overall agreement for all data sets was k = 0.654 indicating substantial agreement between the two cohorts. When the data were split into BI-RADS categories, the level of agreement varied from fair to substantial.

Conclusion
Variations in how radiologists from the USA and UK classify breast density was established, especially when the data were divided into breast density categories. This variation supports the need for a reliable breast density assessment method to enhance the individualized supplemental screening pathways for dense breasts. The use of two-scale categorization method demonstrated improved agreement.

Advances in knowledge
Larger sample of radiologists from different breast density jurisdictions confirms international subjective variability in density categorization and improved agreement with the two-scale (low, high) categorization. With this variability, a standardized and automated breast density assessment shows to be timely.

Item Type: Article
Additional Information: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via Elsevier at https://doi.org/10.1016/j.jmir.2018.11.002 - please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: Breast density; BI-RADS; intrarater variability; mammography
Subjects: R Medicine > R Medicine (General)
R Medicine > RA Public aspects of medicine
Divisions: Faculty of Medicine and Health Sciences > Primary Care Health Sciences
Depositing User: Symplectic
Date Deposited: 17 Jan 2019 09:44
Last Modified: 11 Mar 2019 09:10
URI: http://eprints.keele.ac.uk/id/eprint/5704

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