TY - JOUR
T1 - Effect of mammographic screening modality on breast density assessment
T2 - Digital mammography versus digital breast tomosynthesis
AU - Gastounioti, Aimilia
AU - McCarthy, Anne Marie
AU - Pantalone, Lauren
AU - Synnestvedt, Marie
AU - Kontos, Despina
AU - Conant, Emily F.
N1 - Funding Information:
Study supported by Susan G. Komen for the Cure (PDF17479714) and the National Cancer Institute (NCI)-funded Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium (U54CA163313).
Publisher Copyright:
© RSNA, 2019.
PY - 2019/5
Y1 - 2019/5
N2 - Background: Breast Imaging Reporting and Data System (BI-RADS) breast density categories assigned by interpreting radiologists often influence decisions surrounding supplemental breast cancer screening and risk assessment. The landscape of mammographic screening continuously evolves, and different mammographic screening modalities may result in different perception of density, reflected in different assignment of BI-RADS density categories. Purpose: To investigate the effect of screening mammography modality on BI-RADS breast density assessments. Materials and Methods: Data were retrospectively analyzed from 24 736 individual women (42.3% [10 455 of 24 736] white women, 57.7% [14 281 of 24 736] black women; mean age, 56.3 years; age range, 40.0-74.9 years) who underwent from one to seven mammographic screening examinations from September 2010 through February 2017 (60 766 examinations). Three screening modalities were used: Digital mammography alone (8935 examinations); digital mammography with digital breast tomosynthesis (DBT; 30 779 examinations); and synthetic mammography with DBT (21 052 examinations). Random-effects logistic regression analysis was performed to estimate the likelihood of assignment to high versus low BI-RADS density category according to each modality, adjusted for ethnicity, age, body mass index (BMI), and radiologist. The interactions of modality with ethnicity and BMI on density categorization were also tested with the model. Results: Women screened with DBT versus digital mammography alone had lower likelihood regarding categorization of high density breasts (digital mammography and DBT vs digital mammography: Odds ratio, 0.69 [95% confidence interval: 0.61, 0.80], P , .001; synthetic mammography and DBT vs digital mammography: Odds ratio, 0.43 [95% confidence interval: 0.37, 0.50], P , .001). Lower likelihood of high density was also observed at synthetic mammography and DBT compared with digital mammography and DBT (odds ratio, 0.62; 95% confidence interval: 0.56, 0.69; P , .001). There were interactions of modality with ethnicity (P = .007) and BMI (P = .003) on breast density assessment, with greater differences in density categorization according to modality observed for black women than for white women and groups with higher BMI. Conclusion: Breast density categorization may vary by screening mammographic modality, and this effect appears to vary by ethnicity and body mass index.
AB - Background: Breast Imaging Reporting and Data System (BI-RADS) breast density categories assigned by interpreting radiologists often influence decisions surrounding supplemental breast cancer screening and risk assessment. The landscape of mammographic screening continuously evolves, and different mammographic screening modalities may result in different perception of density, reflected in different assignment of BI-RADS density categories. Purpose: To investigate the effect of screening mammography modality on BI-RADS breast density assessments. Materials and Methods: Data were retrospectively analyzed from 24 736 individual women (42.3% [10 455 of 24 736] white women, 57.7% [14 281 of 24 736] black women; mean age, 56.3 years; age range, 40.0-74.9 years) who underwent from one to seven mammographic screening examinations from September 2010 through February 2017 (60 766 examinations). Three screening modalities were used: Digital mammography alone (8935 examinations); digital mammography with digital breast tomosynthesis (DBT; 30 779 examinations); and synthetic mammography with DBT (21 052 examinations). Random-effects logistic regression analysis was performed to estimate the likelihood of assignment to high versus low BI-RADS density category according to each modality, adjusted for ethnicity, age, body mass index (BMI), and radiologist. The interactions of modality with ethnicity and BMI on density categorization were also tested with the model. Results: Women screened with DBT versus digital mammography alone had lower likelihood regarding categorization of high density breasts (digital mammography and DBT vs digital mammography: Odds ratio, 0.69 [95% confidence interval: 0.61, 0.80], P , .001; synthetic mammography and DBT vs digital mammography: Odds ratio, 0.43 [95% confidence interval: 0.37, 0.50], P , .001). Lower likelihood of high density was also observed at synthetic mammography and DBT compared with digital mammography and DBT (odds ratio, 0.62; 95% confidence interval: 0.56, 0.69; P , .001). There were interactions of modality with ethnicity (P = .007) and BMI (P = .003) on breast density assessment, with greater differences in density categorization according to modality observed for black women than for white women and groups with higher BMI. Conclusion: Breast density categorization may vary by screening mammographic modality, and this effect appears to vary by ethnicity and body mass index.
UR - http://www.scopus.com/inward/record.url?scp=85065050092&partnerID=8YFLogxK
U2 - 10.1148/radiol.2019181740
DO - 10.1148/radiol.2019181740
M3 - Article
C2 - 30888933
AN - SCOPUS:85065050092
SN - 0033-8419
VL - 291
SP - 320
EP - 327
JO - Radiology
JF - Radiology
IS - 2
ER -