Effects of Changes in BI-RADS Density Assessment Guidelines (Fourth Versus Fifth Edition) on Breast Density Assessment: Intra- and Interreader Agreements and Density Distribution

AJR Am J Roentgenol. 2016 Dec;207(6):1366-1371. doi: 10.2214/AJR.16.16561. Epub 2016 Sep 22.

Abstract

Objective: The objective of our study was to determine intra- and interreader agreements for density assessment using the fifth edition of the BI-RADS guidelines and to compare with those for density assessment using the fourth edition of the BI-RADS guidelines.

Materials and methods: Five radiologists assessed breast density four times in 104 mammographic examinations: twice using the fourth edition of the BI-RADS guidelines and twice using the fifth edition. The intra- and interreader agreements for density assessment based on each guideline were determined and compared. The density distribution pattern under each of the four BI-RADS density categories using each guideline was also noted and compared.

Results: The intrareader agreement for density assessment using the fifth-edition criteria was lower than that using the fourth-edition criteria (p = 0.0179). The overall intrareader agreement (weighted kappa) using the old criteria was 0.84 (95% CI, 0.80-0.87), and the individual intrareader agreement values in five readers ranged from 0.78 (95% CI, 0.69-0.88) to 0.92 (95% CI, 0.87-0.97). The overall intrareader agreement using the new BI-RADS criteria was 0.77 (95% CI, 0.73-0.81), and the individual intrareader agreement values in five readers ranged from 0.74 (95% CI, 0.64-0.84) to 0.99 (95% CI, 0.98-1.00). The interreader agreement values obtained using the fifth-edition criteria were also lower than those obtained using the fourth-edition criteria (p = 0.006). The overall interreader agreement using the old BI-RADS criteria was 0.65 (95% CI, 0.61-0.69), whereas the overall interreader agreement using the new BI-RADS criteria was 0.57 (95% CI, 0.53-0.61). Overall a higher number of dense assessments were given when the fifth-edition guidelines were used (p < 0.0001).

Conclusion: Compared with the intra- and interreader agreements obtained using the fourth edition of the BI-RADS guidelines, the intra- and interreader agreements were lower using the fifth-edition guidelines. An increased number of dense assessments were given when the fifth-edition guidelines were used.

Keywords: BI-RADS guidelines; breast density; density assessment; observer agreement; reader agreement.

MeSH terms

  • Absorptiometry, Photon
  • Adult
  • Breast Neoplasms / diagnostic imaging*
  • Breast Neoplasms / physiopathology*
  • Female
  • Guideline Adherence
  • Humans
  • Image Interpretation, Computer-Assisted / standards*
  • Mammography / standards*
  • Medical Oncology / standards
  • Middle Aged
  • Observer Variation
  • Practice Guidelines as Topic*
  • Quality Assurance, Health Care / standards*
  • Radiology / standards
  • Reproducibility of Results
  • Sensitivity and Specificity
  • United States