title: Mammographic density estimation: one-to-one comparison of digital mammography and digital breast tomosynthesis using fully automated software.
abstract: OBJECTIVE
  To compare breast density on digital mammography and digital breast tomosynthesis using fully automated software.
  
  
  METHODS
  Following institutional approval and written informed consent from all participating women, both digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM) were obtained. Breast percentage density was calculated with software on DBT and FFDM.
  
  
  RESULTS
  Fifty consecutive patients (mean age, 51 years; range, 35-83 years) underwent both FFDM and DBT. Using a method based on the integral curve, breast density showed higher results on FFDM (68.1 ± 12.1 for FFDM and 51.9 ± 6.5 for DBT). FFDM overestimated breast density in 16.2% (P < 0.0001). Using a method based on maximum entropy thresholding, breast density showed higher results on FFDM (68.1 ± 12.1 for FFDM and 51.9 ± 6.5 for DBT). FFDM overestimated breast density in 11.4% (P < 0.0001). There was a good correlation among BI-RADS categories on a four-grade scale and the density evaluated with DBT and FFDM (r = 0.54, P < 0.01 and r = 0.44, P < 0.01).
  
  
  CONCLUSIONS
  Breast density appeared to be significantly underestimated on digital breast tomosynthesis.
  
  
  CONCLUSIONS
  Breast density is considered to be an independent risk factor for cancer Density can be assessed on full-field digital mammography and digital breast tomosynthesis Objective automated estimation of breast density eliminates subjectivity Automated estimation is more accurate than BI-RADS quantitative evaluation Breast density may be significantly underestimated on digital breast tomosynthesis.
authors.affiliation: Institute of Anatomy, Department of Experimental Medicine, University of Genoa, Largo Rosanna Benzi 8, 16132 Genoa, Italy. alberto.tagliafico@unige.it
authors.forename: Alberto
authors.initials: A
authors.lastname: Tagliafico
authors.forename: Giulio
authors.initials: G
authors.lastname: Tagliafico
authors.forename: Davide
authors.initials: D
authors.lastname: Astengo
authors.forename: Francesca
authors.initials: F
authors.lastname: Cavagnetto
authors.forename: Raffaella
authors.initials: R
authors.lastname: Rosasco
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rescinito
authors.forename: Francesco
authors.initials: F
authors.lastname: Monetti
authors.forename: Massimo
authors.initials: M
authors.lastname: Calabrese
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D010363:Pattern Recognition, Automated / Q000379:methods*; D011856:Radiographic Image Enhancement / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*