title: Effects of Changes in BI-RADS Density Assessment Guidelines (Fourth Versus Fifth Edition) on Breast Density Assessment: Intra- and Interreader Agreements and Density Distribution.
abstract: OBJECTIVE
  The objective of our study was to determine intra- and interreader agreements for density assessment using the fifth edition of the BI-RADS guidelines and to compare with those for density assessment using the fourth edition of the BI-RADS guidelines.
  
  
  METHODS
  Five radiologists assessed breast density four times in 104 mammographic examinations: twice using the fourth edition of the BI-RADS guidelines and twice using the fifth edition. The intra- and interreader agreements for density assessment based on each guideline were determined and compared. The density distribution pattern under each of the four BI-RADS density categories using each guideline was also noted and compared.
  
  
  RESULTS
  The intrareader agreement for density assessment using the fifth-edition criteria was lower than that using the fourth-edition criteria (p = 0.0179). The overall intrareader agreement (weighted kappa) using the old criteria was 0.84 (95% CI, 0.80-0.87), and the individual intrareader agreement values in five readers ranged from 0.78 (95% CI, 0.69-0.88) to 0.92 (95% CI, 0.87-0.97). The overall intrareader agreement using the new BI-RADS criteria was 0.77 (95% CI, 0.73-0.81), and the individual intrareader agreement values in five readers ranged from 0.74 (95% CI, 0.64-0.84) to 0.99 (95% CI, 0.98-1.00). The interreader agreement values obtained using the fifth-edition criteria were also lower than those obtained using the fourth-edition criteria (p = 0.006). The overall interreader agreement using the old BI-RADS criteria was 0.65 (95% CI, 0.61-0.69), whereas the overall interreader agreement using the new BI-RADS criteria was 0.57 (95% CI, 0.53-0.61). Overall a higher number of dense assessments were given when the fifth-edition guidelines were used (p < 0.0001).
  
  
  CONCLUSIONS
  Compared with the intra- and interreader agreements obtained using the fourth edition of the BI-RADS guidelines, the intra- and interreader agreements were lower using the fifth-edition guidelines. An increased number of dense assessments were given when the fifth-edition guidelines were used.
authors.affiliation: 1 Department of Radiology and Radiological Sciences, Medical University of South Carolina, 169 Ashley Ave, Charleston, SC 29425.
authors.forename: Abid
authors.initials: A
authors.lastname: Irshad
authors.affiliation: 1 Department of Radiology and Radiological Sciences, Medical University of South Carolina, 169 Ashley Ave, Charleston, SC 29425.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Leddy
authors.affiliation: 1 Department of Radiology and Radiological Sciences, Medical University of South Carolina, 169 Ashley Ave, Charleston, SC 29425.
authors.forename: Susan
authors.initials: S
authors.lastname: Ackerman
authors.affiliation: 1 Department of Radiology and Radiological Sciences, Medical University of South Carolina, 169 Ashley Ave, Charleston, SC 29425.
authors.forename: Abbie
authors.initials: A
authors.lastname: Cluver
authors.affiliation: 1 Department of Radiology and Radiological Sciences, Medical University of South Carolina, 169 Ashley Ave, Charleston, SC 29425.
authors.forename: Dag
authors.initials: D
authors.lastname: Pavic
authors.affiliation: 2 University of South Carolina School of Medicine, Columbia, SC.
authors.forename: Ahad
authors.initials: A
authors.lastname: Abid
authors.affiliation: 1 Department of Radiology and Radiological Sciences, Medical University of South Carolina, 169 Ashley Ave, Charleston, SC 29425.
authors.forename: Madelene C
authors.initials: MC
authors.lastname: Lewis
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000592:standards*; D008327:Mammography / Q000592:standards*; D008495:Medical Oncology / Q000592:standards; D008875:Middle Aged; D015588:Observer Variation; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care / Q000592:standards*; D011871:Radiology / Q000592:standards; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014481:United States
keywords: BI-RADS guidelines; breast density; density assessment; observer agreement; reader agreement