Breast Percent Density: Estimation on Digital Mammograms and Central Tomosynthesis Projections

Purpose: To evaluate inter- and intrareader agreement in breast percent density (PD) estimation on clinical digital mammograms and central digital breast tomosynthesis (DBT) projection images. Materials and Methods: This HIPAA-compliant study had institutional review board approval; all patients provided informed consent. Breast PD estimation was performed on the basis of anonymized digital mammograms and central DBT projections in 39 women ( mean age, 51 years; range, 31-80 years). All women had recently detected abnormalities or biopsyproved cancers. PD was estimated by three experienced readers on the mediolateral oblique views of the contralateral breasts by using software; each reader repeated the estimation after 2 months. Spearman correlations of inter- and intrareader and intermodality PD estimates, as well as kappa statistics between categoric PD estimates, were computed. Results: High correlation (rho = 0.91) was observed between PD estimates on digital mammograms and those on central DBT projections, averaged over all estimations; the corresponding kappa coefficient (0.79) indicated substantial agreement. Mean interreader agreement for PD estimation on central DBT projections (rho = 0.85 +/- 0.05 [standard deviation]) was significantly higher (P < .01) than that for PD estimation on digital mammograms (rho = 0.75 +/- 0.05); the corresponding kappa coefficients indicated substantial (kappa = 0.65 +/- 0.12) and moderate (kappa = 0.55 +/- 0.14) agreement for central DBT projections and digital mammograms, respectively. Conclusion: High correlation between PD estimates on digital mammograms and those on central DBT projections suggests the latter could be used until a method for PD estimation based on three-dimensional reconstructed images is introduced. Moreover, clinical PD estimation is possible with reduced radiation dose, as each DBT projection was acquired by using about 22% of the dose for a single mammographic projection.