title: Postmortem validation of breast density using dual-energy mammography.
abstract: OBJECTIVE
  Mammographic density has been shown to be an indicator of breast cancer risk and also reduces the sensitivity of screening mammography. Currently, there is no accepted standard for measuring breast density. Dual energy mammography has been proposed as a technique for accurate measurement of breast density. The purpose of this study is to validate its accuracy in postmortem breasts and compare it with other existing techniques.
  
  
  METHODS
  Forty postmortem breasts were imaged using a dual energy mammography system. Glandular and adipose equivalent phantoms of uniform thickness were used to calibrate a dual energy basis decomposition algorithm. Dual energy decomposition was applied after scatter correction to calculate breast density. Breast density was also estimated using radiologist reader assessment, standard histogram thresholding and a fuzzy C-mean algorithm. Chemical analysis was used as the reference standard to assess the accuracy of different techniques to measure breast composition.
  
  
  RESULTS
  Breast density measurements using radiologist reader assessment, standard histogram thresholding, fuzzy C-mean algorithm, and dual energy were in good agreement with the measured fibroglandular volume fraction using chemical analysis. The standard error estimates using radiologist reader assessment, standard histogram thresholding, fuzzy C-mean, and dual energy were 9.9%, 8.6%, 7.2%, and 4.7%, respectively.
  
  
  CONCLUSIONS
  The results indicate that dual energy mammography can be used to accurately measure breast density. The variability in breast density estimation using dual energy mammography was lower than reader assessment rankings, standard histogram thresholding, and fuzzy C-mean algorithm. Improved quantification of breast density is expected to further enhance its utility as a risk factor for breast cancer.
authors.affiliation: Department of Radiological Sciences, University of California, Irvine, California 92697.
authors.forename: Sabee
authors.initials: S
authors.lastname: Molloi
authors.affiliation: Department of Radiological Sciences, University of California, Irvine, California 92697.
authors.forename: Justin L
authors.initials: JL
authors.lastname: Ducote
authors.affiliation: Department of Radiological Sciences, University of California, Irvine, California 92697.
authors.forename: Huanjun
authors.initials: H
authors.lastname: Ding
authors.affiliation: Department of Radiological Sciences, University of California, Irvine, California 92697.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Feig
mesh_terms: D000465:Algorithms; D000071060:Breast Density; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D002138:Calibration; D005260:Female; D017143:Fuzzy Logic; D006801:Humans; D016014:Linear Models; D042361:Mammary Glands, Human / Q000002:abnormalities*; D008327:Mammography / Q000295:instrumentation / Q000379:methods*; D009929:Organ Size; D019047:Phantoms, Imaging
references.citation: Breast. 2007 Dec;16(6):568-76
references.pmid: 18035541
references.citation: Acad Radiol. 2001 Mar;8(3):250-6
references.pmid: 11249089
references.citation: AJR Am J Roentgenol. 2000 Jun;174(6):1769-77
references.pmid: 10845521
references.citation: Radiology. 2013 Jan;266(1):81-8
references.pmid: 23150865
references.citation: Cancer Epidemiol. 2011 Apr;35(2):188-93
references.pmid: 20688593
references.citation: Eur J Radiol. 2006 Nov;60(2):275-8
references.pmid: 17049196
references.citation: Radiology. 2010 Mar;254(3):793-800
references.pmid: 20177093
references.citation: Med Phys. 2013 Dec;40(12):122305
references.pmid: 24320536
references.citation: Am J Hum Biol. 2011 May-Jun;23(3):359-65
references.pmid: 21445936
references.citation: Can J Biochem Physiol. 1959 Aug;37(8):911-7
references.pmid: 13671378
references.citation: Breast Cancer Res Treat. 2013 Feb;138(1):311-7
references.pmid: 23338763
references.citation: Med Phys. 2012 Aug;39(8):4903-17
references.pmid: 22894417
references.citation: Phys Med Biol. 2012 Aug 7;57(15):4719-38
references.pmid: 22771941
references.citation: Med Phys. 2009 Dec;36(12):5525-36
references.pmid: 20095265
references.citation: Epidemiol Rev. 1993;15(1):196-208
references.pmid: 8405204
references.citation: Epidemiol Rev. 1987;9:146-74
references.pmid: 3315715
references.citation: CA Cancer J Clin. 2012 Mar-Apr;62(2):129-42
references.pmid: 22261986
references.citation: Cancer Epidemiol Biomarkers Prev. 2004 May;13(5):715-22
references.pmid: 15159301
references.citation: Radiology. 1993 Aug;188(2):297-301
references.pmid: 8327668
references.citation: JAMA. 2006 May 24;295(20):2374-84
references.pmid: 16720823
references.citation: J Natl Cancer Inst. 1995 May 3;87(9):670-5
references.pmid: 7752271
references.citation: JAMA. 2008 May 14;299(18):2151-63
references.pmid: 18477782
references.citation: Med Phys. 2010 Jan;37(1):164-74
references.pmid: 20175478
references.citation: Radiology. 2008 Feb;246(2):348-53
references.pmid: 18227535
references.citation: Radiology. 2002 May;223(2):554-7
references.pmid: 11997567
references.citation: J Natl Cancer Inst. 2004 Oct 6;96(19):1432-40
references.pmid: 15467032
references.citation: Med Phys. 2002 Aug;29(8):1867-80
references.pmid: 12201434
references.citation: Radiol Clin North Am. 2004 Sep;42(5):845-51, vi
references.pmid: 15337420
references.citation: Med Phys. 2010 May;37(5):2017-29
references.pmid: 20527535
references.citation: Med Phys. 2006 Aug;33(8):2998-3005
references.pmid: 16964878
references.citation: N Engl J Med. 2007 Jan 18;356(3):227-36
references.pmid: 17229950
references.citation: Radiology. 2006 Sep;240(3):656-65
references.pmid: 16857974
references.citation: Phys Med Biol. 2007 Oct 7;52(19):5881-95
references.pmid: 17881806
references.citation: Cancer Epidemiol Biomarkers Prev. 2006 Jun;15(6):1159-69
references.pmid: 16775176
references.citation: Radiology. 2013 Apr;267(1):47-56
references.pmid: 23297332
references.citation: Med Phys. 2014 Mar;41(3):031915
references.pmid: 24593733
references.citation: Radiology. 2013 May;267(2):657-8
references.pmid: 23610099
references.citation: AJR Am J Roentgenol. 2009 Feb;192(2):390-9
references.pmid: 19155400
references.citation: Ann Intern Med. 2003 Feb 4;138(3):168-75
references.pmid: 12558355
references.citation: Cancer Detect Prev. 1992;16(1):67-72
references.pmid: 1532349
references.citation: Cancer Epidemiol Biomarkers Prev. 2006 May;15(5):961-6
references.pmid: 16702377
references.citation: Med Phys. 2010 Feb;37(2):793-801
references.pmid: 20229889
references.citation: Cancer Epidemiol Biomarkers Prev. 2008 Jul;17(7):1709-13
references.pmid: 18628421
references.citation: JAMA. 2012 Apr 4;307(13):1394-404
references.pmid: 22474203
references.citation: Med Phys. 2011 Aug;38(8):4498-504
references.pmid: 21928619
references.citation: J Natl Cancer Inst. 1995 Nov 1;87(21):1622-9
references.pmid: 7563205
references.citation: Phys Med Biol. 2012 Aug 21;57(16):5155-68
references.pmid: 22842727
references.citation: AJR Am J Roentgenol. 1976 Jun;126(6):1130-7
references.pmid: 179369
references.citation: Med Phys. 2003 Mar;30(3):352-64
references.pmid: 12674236
references.citation: Ann Intern Med. 2011 Jul 5;155(1):10-20
references.pmid: 21727289
references.citation: Phys Med Biol. 2006 Jun 7;51(11):2695-713
references.pmid: 16723760
references.citation: Radiology. 2012 Oct;265(1):59-69
references.pmid: 22723501
references.citation: Phys Med Biol. 2013 Dec 7;58(23):8573-91
references.pmid: 24254317
references.citation: J Am Coll Radiol. 2010 Jan;7(1):18-27
references.pmid: 20129267
references.citation: J Natl Cancer Inst. 2013 Jul 17;105(14):1043-9
references.pmid: 23744877
references.citation: Lancet Oncol. 2013 Jun;14(7):583-9
references.pmid: 23623721
references.citation: JAMA. 1996 Jul 3;276(1):33-8
references.pmid: 8667536
references.citation: Med Phys. 2013 Jun;40(6):061902
references.pmid: 23718593
references.citation: Phys Med Biol. 1994 Oct;39(10):1629-38
references.pmid: 15551535
references.citation: Med Phys. 2007 Jun;34(6):1918-25
references.pmid: 17654894
references.citation: Br J Cancer. 2006 Oct 9;95(7):801-10
references.pmid: 17016484