A self-directed learning intervention for radiographers rating mammographic breast density

A systematic review and meta-analysis of correlation of automated breast density measurement

INTRODUCTION

Breast cancer is the most common cancer in women and a leading cause of mortality. This systematic review and meta-analysis aims to evaluate the correlation between breast density measurements obtained from various software and visual assessments by radiologists using full-field digital mammography (FFDM).

METHODS

Following the PRISMA 2020 guidelines, five databases (Pubmed, Google Scholar, Science Direct, Cochrane Library, and MEDLINE) were searched for studies correlating volumetric breast density with breast cancer risk. The Newcastle-Ottawa Scale and the Joanna Briggs Institute Checklist were used to assess the quality of the included studies. Meta-analysis of correlation was applied to aggregate correlation coefficients using a random-effects model using MedCalc Statistical Software version 19.2.6.

RESULTS

The review included 22 studies with a total of 58,491 women. The pooled correlation coefficient for volumetric breast density amongst Volpara™ and Quantra™ was found to be 0.755 (95% CI 0.496-0.890, p < 0.001), indicating a high positive correlation, albeit with a significant heterogeneity (I2 = 99.89%, p < 0.0001). Subgroup analyses based on study origin, quality, and methodology were performed but did not reveal the heterogeneity cause. Egger's and Begg's tests showed no significant publication bias.

CONCLUSION

Volumetric breast density is strongly correlated with breast cancer risk, underscoring the importance of accurate breast density assessment in screening programs. Automated volumetric measurement tools like Volpara™ and Quantra™ provide reliable assessments, potentially improving breast cancer risk prediction and management.

IMPLICATIONS FOR PRACTICE

Implementing fully automated breast density assessment tools could enhance consistency in clinical practice, minimizing observer variability and improving screening accuracy. These tools should be further validated against standardized criteria to ensure reliability in diverse clinical settings.

The Usefulness of the Breast Density Assessment Application Used by Breast Radiologists

Breast density determined by breast radiologists and also automatically estimated by applications has been widely investigated. However, no study has yet clarified whether the use of these applications by breast radiologists improves reading efficacy. Therefore, this study aimed to assess the usefulness of applications when used by breast radiologists. A Breast Density Assessment application (App) developed by Konica Minolta, Inc. (Tokyo, Japan) was used. Independent and sequential tests were conducted to assess the usefulness of the concurrent- and second-look modes. Fifty and 100 cases were evaluated using sequential and independent tests, respectively. Each dataset was configured based on the evaluation by an expert breast radiologist who developed the Japanese guidelines for breast density. Nine breast radiologists evaluated the mammary gland content ratio and breast density; the inter-observer and expert-to-observer variability were calculated. The time required to complete the experiments was also recorded. The inter-observer variability was significant with the App, as revealed by the independent test. The use of the App significantly improved the agreement between the responses of the observers for the mammary gland content ratio and those of the expert by 6.6% and led to a reduction of 186.9 seconds in the average time required by the observers to evaluate 100 cases. However, the results of the sequential test did not suggest the effectiveness of the App. These findings suggest that the concurrent use of the App improves reading efficiency.

MRI interobserver reliability in rectal tumor angulation

Background

When rectal tumors are examined using magnetic resonance imaging (MRI) the perpendicular angulation of the axial T2-weighted image to the tumor axis is essential for a correct measure of the shortest distance between tumor and mesorectal facia.

Purpose

The purpose of this study was to determine the interobserver variability in rectal tumor angulation between a radiologist and a radiographer.

Material and Methods

Two observers performed the angulation independently. All MRI examinations were performed using an MRI 1.5 Tesla unit. A Bland–Altman plot was used to assess the interobserver variance and Intraclass correlation coefficient (ICC) statistic was used to assess the interobserver reliability.

Results

MRI was performed in 55 patients with rectal cancer during a one-year period (25 (45.5%) women and 30 (54.5%) men). The median age was 71 years (range 46–87 years). The rectal tumor mean length was 3.9 cm. The interobserver reliability was good (ICC = 0.83, 95% confidence interval 0.72–0.90).

Conclusion

Radiographers receiving training will be able to perform MRI rectal tumor angulation.