Comparing Visually Assessed BI-RADS Breast Density and Automated Volumetric Breast Density Software: A Cross-Sectional Study in a Breast Cancer Screening Setting

INTRODUCTION: The objective of this study is to compare different methods for measuring breast density, both visual assessments and automated volumetric density, in a breast cancer screening setting. These measures could potentially be implemented in future screening programmes, in the context of personalised screening or screening evaluation. MATERIALS AND METHODS: Digital mammographic exams (N = 992) of women participating in the Dutch breast cancer screening programme (age 50–75y) in 2013 were included. Breast density was measured in three different ways: BI-RADS density (5(th) edition) and with two commercially available automated software programs (Quantra and Volpara volumetric density). BI-RADS density (ordinal scale) was assessed by three radiologists. Quantra (v1.3) and Volpara (v1.5.0) provide continuous estimates. Different comparison methods were used, including Bland-Altman plots and correlation coefficients (e.g., intraclass correlation coefficient [ICC]). RESULTS: Based on the BI-RADS classification, 40.8% of the women had ‘heterogeneously or extremely dense’ breasts. The median volumetric percent density was 12.1% (IQR: 9.6–16.5) for Quantra, which was higher than the Volpara estimate (median 6.6%, IQR: 4.4–10.9). The mean difference between Quantra and Volpara was 5.19% (95% CI: 5.04–5.34) (ICC: 0.64). There was a clear increase in volumetric percent dense volume as BI-RADS density increased. The highest accuracy for predicting the presence of BI-RADS c+d (heterogeneously or extremely dense) was observed with a cut-off value of 8.0% for Volpara and 13.8% for Quantra. CONCLUSION: Although there was no perfect agreement, there appeared to be a strong association between all three measures. Both volumetric density measures seem to be usable in breast cancer screening programmes, provided that the required data flow can be realized.