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Interobserver agreement in breast radiological density attribution according to BI-RADS quantitative classification

Riproducibilità interlettore del giudizio relativo alla densità radiologica secondo la classificazione quantitativa BI-RADS

  • Breast Radiology / Senologia
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

The authors sought to assess interobserver agreement in classifying mammography density according to quantitative Breast Imaging Reporting and Data System (BI-RADS) criteria.

Materials and methods

Six expert mammography readers were tested on a set of 100 mammograms. Interobserver agreement was determined according to the kappa statistic, adjusting for chance agreement, on a four-category (D1 vs. D2 vs. D3 vs. D4) or two-category (D1–2 vs. D3–4) basis. Agreement with a panel of 12 readers who had been tested on the same set in a previous study was also assessed.

Results

The six readers showed good agreement when compared in pairs [agreement on a four-category basis was substantial (kappa=0.60–0.80) for 13 pairs and almost perfect (kappa>0.80) for two pairs); agreement on a two-category basis was substantial for 12 pairs and almost perfect for three pairs) or compared with the panel (on a four-category basis, agreement was substantial for five of six readers and almost perfect for one; on a two-category basis, agreement was substantial for all readers).

Conclusions

In agreement with previous studies, visual classification of mammography density according to BI-RADS quantitative criteria was highly reproducible among readers; nevertheless, attribution to the “dense breast” (BI-RADS D3–4) category, which might be adopted as a determinant of different screening protocols (such as adjunct ultrasonography or yearly interval) varied among readers (range 6–15%). Controlled studies should be performed comparing visual with computer-density category attribution, the latter possibly being a better alternative due to its absolute reproducibility.

Riassunto

Obiettivo

Scopo del presente lavoro è stato verificare la riproducibilità interosservatore nel classificare la densità mammografica in base ai criteri della classificazione quantitative Breast Imaging Reporting and Data System (BI-RADS).

Materiali e metodi

Sei lettori esperti di mammografia sono stati testati su un set di 100 mammografie. La concordanza interosservatore è stata valutata mediante la statistica kappa, che aggiusta per la concordanza casuale, rispetto a quattro (D1 vs. D2 vs. D3 vs. D4) o due categorie (D1–2 vs. D3–4). È stata verificata anche la concordanza con un panel di 12 lettori che avevano valutato lo stesso set di mammografie in uno studio precedente.

Risultati

I sei lettori hanno mostrato una buona concordanza quando confrontati in coppie (concordanza sulla base di quattro categorie sostanziale (kappa=0,60–0,80) per 13 coppie e quasi perfetta (kappa>0,80) per due coppie; concordanza sulla base di due categorie sostanziale per 12 coppie, quasi perfetta per tre) o rispetto al panel (concordanza sulla base di quattro categorie sostanziale per 5/6 lettori e quasi perfetta per un lettore; concordanza sulla base di due categorie sostanziale per tutti i lettori).

Conclusioni

In accordo con precedenti studi la classificazione visuale della densità mammografica secondo i criteri BI-RADS è risultata altamente riproducibile tra i diversi lettori: ciò nonostante l’attribuzione della categoria seno denso (BI-RADS D3–4), che potrebbe essere adottata come determinante di protocolli di screening differenziati (aggiunta dell’ecografia, frequenza annuale) varia tra i lettori (in questo studio dal 6% al 15%). Necessitano studi controllati che confrontino la classificazione visuale con quella computerizzata, potendo quest’ultima essere una valida alternativa per la sua riproducibilità assoluta.

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Authors and Affiliations

  1. U.O. Senologia Clinica e Screening Mammografico, Dipartimento di Radiodiagnostica, APSS Trento I, Viale Verona Centro per i Servizi Sanitari, Palazzina C, Piano Terrazza, 38100, Trento, Italy

    D. Bernardi, M. Pellegrini, S. Di Michele, P. Tuttobene, C. Fantò & M. Valentini

  2. Servizio Osservatorio epidemiologico, Direzione Promozione ed educazione alla Salute, APSS, Trento, Italy

    M. Gentilini

  3. ULSS 16, Centro Prevenzione Screening, Padova, Italy

    S. Ciatto

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  1. D. Bernardi
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  2. M. Pellegrini
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  3. S. Di Michele
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  4. P. Tuttobene
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  7. M. Gentilini
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  8. S. Ciatto
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Correspondence to D. Bernardi.

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Bernardi, D., Pellegrini, M., Di Michele, S. et al. Interobserver agreement in breast radiological density attribution according to BI-RADS quantitative classification. Radiol med 117, 519–528 (2012). https://doi.org/10.1007/s11547-011-0777-3

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  • DOI: https://doi.org/10.1007/s11547-011-0777-3

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