title: Estimation of percentage breast tissue density: comparison between digital mammography (2D full field digital mammography) and digital breast tomosynthesis according to different BI-RADS categories.
abstract: OBJECTIVE
  To compare breast density estimated from two-dimensional full-field digital mammography (2D FFDM) and from digital breast tomosynthesis (DBT) according to different Breast Imaging-Reporting and Data System (BI-RADS) categories, using automated software.
  
  
  METHODS
  Institutional review board approval and written informed patient consent were obtained. DBT and 2D FFDM were performed in the same patients to allow within-patient comparison. A total of 160 consecutive patients (mean age: 50±14 years; mean body mass index: 22±3) were included to create paired data sets of 40 patients for each BI-RADS category. Automatic software (MedDensity(©), developed by Giulio Tagliafico) was used to compare the percentage breast density between DBT and 2D FFDM. The estimated breast percentage density obtained using DBT and 2D FFDM was examined for correlation with the radiologists' visual BI-RADS density classification.
  
  
  RESULTS
  The 2D FFDM differed from DBT by 16.0% in BI-RADS Category 1, by 11.9% in Category 2, by 3.5% in Category 3 and by 18.1% in Category 4. These differences were highly significant (p<0.0001). There was a good correlation between the BI-RADS categories and the density evaluated using 2D FFDM and DBT (r=0.56, p<0.01 and r=0.48, p<0.01, respectively).
  
  
  CONCLUSIONS
  Using DBT, breast density values were lower than those obtained using 2D FFDM, with a non-linear relationship across the BI-RADS categories. These data are relevant for clinical practice and research studies using density in determining the risk.
  
  
  CONCLUSIONS
  On DBT, breast density values were lower than with 2D FFDM, with a non-linear relationship across the classical BI-RADS categories.
authors.affiliation: Department of Experimental Medicine, University of Genova, Genova, Italy.
authors.forename: A S
authors.initials: AS
authors.lastname: Tagliafico
authors.forename: G
authors.initials: G
authors.lastname: Tagliafico
authors.forename: F
authors.initials: F
authors.lastname: Cavagnetto
authors.forename: M
authors.initials: M
authors.lastname: Calabrese
authors.forename: N
authors.initials: N
authors.lastname: Houssami
mesh_terms: D001940:Breast / Q000166:cytology / Q000473:pathology; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D011856:Radiographic Image Enhancement / Q000379:methods*; D012984:Software; D014056:Tomography, X-Ray
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