title: Agreement between Breast Percentage Density Estimations from Standard-Dose versus Synthetic Digital Mammograms: Results from a Large Screening Cohort Using Automated Measures.
abstract: Purpose To evaluate agreement between automated estimates of breast density made from standard-dose versus synthetic digital mammograms in a large cohort of women undergoing screening. Materials and Methods This study received institutional review board approval with waiver of consent. A total of 3668 negative (Breast Imaging Reporting and Data System category 1 or 2) digital breast tomosynthesis (DBT) screening examinations consecutively performed over a 4-month period at one institution for which both standard-dose and synthetic mammograms were available for analysis were retrospectively analyzed. All mammograms were acquired with a Selenia Dimensions system (Hologic, Bedford, Mass), and synthetic mammograms were generated by using the U.S. Food and Drug Administration-approved "C-View" software module. The "For Presentation" standard-dose mammograms and synthetic images were analyzed by using a fully automated algorithm. Agreement between density estimates was assessed by using Pearson correlation, linear regression, and Bland-Altman analysis. Differences were evaluated by using the paired Student t test. Results Breast percentage density (PD) estimates from synthetic and standard-dose mammograms were highly correlated (r = 0.92, P < .001), and the 95% Bland-Altman limits of agreement between PD estimates were -6.4% to 9.9%. Synthetic mammograms had PD estimates by an average of 1.7% higher than standard-dose mammograms (P < .001), with a larger disagreement by 1.56% in women with highly dense breast tissue (P < .0001). Conclusion Fully automated estimates of breast density made from synthetic mammograms are generally comparable to those made from standard-dose mammograms. This may be important, as standard two-dimensional mammographic images are increasingly being replaced by synthetic mammograms in DBT screening in an attempt to reduce radiation dose.©RSNA, 2017 Online supplemental material is available for this article.
authors.affiliation: From the Department of Radiology, University of Pennsylvania, Room D702, Richards Bldg, 3700 Hamilton Walk, Philadelphia, PA 19104.
authors.forename: Emily F
authors.initials: EF
authors.lastname: Conant
authors.affiliation: From the Department of Radiology, University of Pennsylvania, Room D702, Richards Bldg, 3700 Hamilton Walk, Philadelphia, PA 19104.
authors.forename: Brad M
authors.initials: BM
authors.lastname: Keller
authors.affiliation: From the Department of Radiology, University of Pennsylvania, Room D702, Richards Bldg, 3700 Hamilton Walk, Philadelphia, PA 19104.
authors.forename: Lauren
authors.initials: L
authors.lastname: Pantalone
authors.affiliation: From the Department of Radiology, University of Pennsylvania, Room D702, Richards Bldg, 3700 Hamilton Walk, Philadelphia, PA 19104.
authors.forename: Aimilia
authors.initials: A
authors.lastname: Gastounioti
authors.affiliation: From the Department of Radiology, University of Pennsylvania, Room D702, Richards Bldg, 3700 Hamilton Walk, Philadelphia, PA 19104.
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: McDonald
authors.affiliation: From the Department of Radiology, University of Pennsylvania, Room D702, Richards Bldg, 3700 Hamilton Walk, Philadelphia, PA 19104.
authors.forename: Despina
authors.initials: D
authors.lastname: Kontos
mesh_terms: D000328:Adult; D000368:Aged; D000071060:Breast Density; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods; D008875:Middle Aged; D012189:Retrospective Studies