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Keywords:
Breast, Mammography, Technology assessment, Cancer
Authors:
C. Tromans1, R. Highnam1, O. Morrish2, R. Black2, L. Tucker2, F. J. Gilbert2; 1Wellington/NZ, 2Cambridge/UK
DOI:
10.1594/ecr2014/C-0363
Aims and objectives
Breast density reporting is a legal requirement in several US states,
and clinical decisions are increasingly being made based upon these breast density results,
in the US and elsewhere.
The BI-RADS definition of the overall breast composition is “an assessment of the volume of attenuating tissues in the breast” [1].
Currently the radiologist assesses the volume of attenuating tissue in the breast by visually inspecting the craniocaudal (CC) and mediolateral oblique (MLO) mammograms and reporting the appropriate BI-RADS density category: 1) Almost entirely fatty; 2) Scattered fibroglandular densities; 3) Heterogeneously dense; and 4) Extremely dense.
There is high inter- and intra-reader variability in the assessment of breast density [2].
Recently,
commercial systems have come to market (i.e.
Volpara™ and Quantra™),
which provide automated volumetric breast density assessments from 2D mammograms giving objective,
consistent measurements [3-5]. These systems have been shown to be highly correlated with breast density measurements produced from MRI [6].
Digital breast tomosynthesis (DBT) is a promising new modality to improve screening for breast cancer.
When DBT is used in “combo” mode,
the conventional CC and MLO mammograms are taken at the same time as a series of low dose mammograms.
These projection images are then used to reconstruct a pseudo-3D image of the breast.
In this scenario,
breast density can be assessed using the conventional CC and MLO mammograms.
In the future,
however,
it appears highly likely that only the pseudo-3D images and synthetic 2D views may be available to the radiologist,
in order to keep radiation dose to a minimum. Currently,
there is no published data comparing radiologists’ assessments of breast density from the 3D image or from the synthesized 2D views,
with density assessed using the conventional CC and MLO mammograms.
In this study,
we assess one of the commercial systems measurements of volumetric breast density (Volpara™) of conventional 2D mammograms and compare this to assessment of DBT volumetric density.