Automated and Clinical Breast Imaging Reporting and Data System Density Measures Predict Risk for Screen-Detected and Interval Cancers A Case-Control Study

作者：Kerlikowske Karla^*; Scott Christopher G; Mahmoudzadeh Amir P; Ma Lin; Winham Stacey; Jensen Matthew R; Wu Fang Fang; Malkov Serghei; Pankratz V Shane; Cummings Steven R; Shepherd John A; Brandt Kathleen R; Miglioretti Diana L; Vachon Celine M

来源：Annals of Internal Medicine, 2018, 168(11): 757-+.

DOI：10.7326/M17-3008

Background: In 30 states, women who have had screening mammography are informed of their breast density on the basis of Breast Imaging Reporting and Data System (BI-RADS) density categories estimated subjectively by radiologists. Variation in these clinical categories across and within radiologists has led to discussion about whether automated BI-RADS density should be reported instead.
Objective: To determine whether breast cancer risk and detection are similar for automated and clinical BI-RADS density measures.
Design: Case-control.
Setting: San Francisco Mammography Registry and Mayo Clinic.
Participants: 1609 women with screen-detected cancer, 351 women with interval invasive cancer, and 4409 matched control participants.
Measurements: Automated and clinical BI-RADS density assessed on digital mammography at 2 time points from September 2006 to October 2014, interval and screen-detected breast cancer risk, and mammography sensitivity.
Results: Of women whose breast density was categorized by automated BI-RADS more than 6 months to 5 years before diagnosis, those with extremely dense breasts had a 5.65-fold higher interval cancer risk (95% CI, 3.33 to 9.60) and a 1.43-fold higher screen-detected risk (CI, 1.14 to 1.79) than those with scattered fibroglandular densities. Associations of interval and screen-detected cancer with clinical BI-RADS density were similar to those with automated BI-RADS density, regardless of whether density was measured more than 6 months to less than 2 years or 2 to 5 years before diagnosis. Automated and clinical BI-RADS density measures had similar discriminatory accuracy, which was higher for interval than screen-detected cancer (c-statistics: 0.70 vs. 0.62 [P < 0.001] and 0.72 vs. 0.62 [P < 0.001], respectively). Mammography sensitivity was similar for automated and clinical BI-RADS categories: fatty, 93% versus 92%; scattered fibroglandular densities, 90% versus 90%; heterogeneously dense, 82% versus 78%; and extremely dense, 63% versus 64%, respectively.
Limitation: Neither automated nor clinical BI-RADS density was assessed on tomosynthesis, an emerging breast screening method.
Conclusion: Automated and clinical BI-RADS density similarly predict interval and screen-detected cancer risk, suggesting that either measure may be used to inform women of their breast density.

• 出版日期2018-6-5