title: Radiological assessment of breast density by visual classification (BI-RADS) compared to automated volumetric digital software (Quantra): implications for clinical practice.
abstract: OBJECTIVE
  This study was done to assess breast density on digital mammography and digital breast tomosynthesis according to the visual Breast Imaging Reporting and Data System (BI-RADS) classification, to compare visual assessment with Quantra software for automated density measurement, and to establish the role of the software in clinical practice.
  
  
  METHODS
  We analysed 200 digital mammograms performed in 2D and 3D modality, 100 of which positive for breast cancer and 100 negative. Radiological density was assessed with the BI-RADS classification; a Quantra density cut-off value was sought on the 2D images only to discriminate between BI-RADS categories 1-2 and BI-RADS 3-4. Breast density was correlated with age, use of hormone therapy, and increased risk of disease.
  
  
  RESULTS
  The agreement between the 2D and 3D assessments of BI-RADS density was high (K 0.96). A cut-off value of 21% is that which allows us to best discriminate between BI-RADS categories 1-2 and 3-4. Breast density was negatively correlated to age (r = -0.44) and positively to use of hormone therapy (p = 0.0004). Quantra density was higher in breasts with cancer than in healthy breasts.
  
  
  CONCLUSIONS
  There is no clear difference between the visual assessments of density on 2D and 3D images. Use of the automated system requires the adoption of a cut-off value (set at 21%) to effectively discriminate BI-RADS 1-2 and 3-4, and could be useful in clinical practice.
authors.affiliation: S.C. Radiologia Universitaria, Università di Torino, Dipartimento di Diagnostica per Immagini e Radioterapia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Turin, Italy, elisa.regini@libero.it.
authors.forename: Elisa
authors.initials: E
authors.lastname: Regini
authors.forename: Giovanna
authors.initials: G
authors.lastname: Mariscotti
authors.forename: Manuela
authors.initials: M
authors.lastname: Durando
authors.forename: Gianluca
authors.initials: G
authors.lastname: Ghione
authors.forename: Andrea
authors.initials: A
authors.lastname: Luparia
authors.forename: Pier Paolo
authors.initials: PP
authors.lastname: Campanino
authors.forename: Caterina Chiara
authors.initials: CC
authors.lastname: Bianchi
authors.forename: Laura
authors.initials: L
authors.lastname: Bergamasco
authors.forename: Paolo
authors.initials: P
authors.lastname: Fonio
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gandini
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D055088:Early Detection of Cancer / Q000379:methods; D015914:Estrogen Replacement Therapy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods; D008875:Middle Aged; D011856:Radiographic Image Enhancement; D011857:Radiographic Image Interpretation, Computer-Assisted; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors