Persistent inter-observer variability of breast density assessment using BI-RADS® 5th edition guidelines.
Persistent inter-observer variability of breast density assessment using BI-RADS® 5th edition guidelines.
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DOI：
10.1016/j.clinimag.2021.11.034
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发表时间：
2022-03
期刊：
影响因子：
2.1
通讯作者：
Raza S
中科院分区：
文献类型：
--
作者：
Portnow LH;Georgian-Smith D;Haider I;Barrios M;Bay CP;Nelson KP;Raza S
由于大多数州的立法，乳房x线摄影密度分类具有潜在的深远影响，但基于BIRADS®指南仍然是主观的。我们的目的是确定1)BI-RADS®第5版（第5版）与第4版（第4版）指南在密度评估方面的读者一致性的影响；2)第5版与第4版密度分布，目测与定量评估一致性；3)经验丰富的读者与经验不足的读者之间的一致性。在一项回顾性研究中，6位乳腺成像放射科医生（BIR）（23-30年经验）使用第5版指南，对2012年9月至2013年1月进行的200张乳房x光筛查照片的密度进行了视觉评估。研究人员将结果与2016年的数据进行了比较，这些数据是由同样的读者在培训模块后使用第4版指南评估同样的乳房x光片。7名初级BIR（1-5年经验）与8名资深BIR的密度分类进行了比较。计算了Nelson等人的kappas （Km,Kw）、Fleiss的KF和Cohen的K。使用Volpara的定量密度与读者评估进行了比较。使用第5版的读者间加权一致性中等强，为0.73 (Kw, s.e.= 0.01)，与第4版相似，为0.71 （Kw, s.e.= 0.03）。读者内部的科恩系数为0.23-0.34，与第4版相似。二元非密集分类与密集分类，使用第5版的结果比第4版的结果更密集（p<0.001）。5 -ed密度分布导致B/C类数量高于4 -ed （p<0.001）。五年级学生的分布不会因读者经验而有所不同（p=0.09）。读者与定量加权协议相似（第5版，Cohen的k= 0.76-0.85；第4版，Cohen的k= 0.68-0.83）。使用第5版指南目测乳房x线片密度存在持续的主观性；经验与更好的读者间共识无关。
Due to most states’ legislation, mammographic density categorization has potentially far-reaching implications, but remains subjective based on BIRADS® guidelines. We aimed to determine 1) effect of BI-RADS® 5th edition (5th-ed) vs 4th-edition (4th-ed) guidelines on reader agreement regarding density assessment; 2) 5th-ed vs 4th-ed density distribution, and visual vs quantitative assessment agreement; 3) agreement between experienced vs less experienced readers. In a retrospective review, six breast imaging radiologists (BIR) (23–30 years’ experience) visually assessed density of 200 screening mammograms performed September 2012–January 2013 using 5th-ed guidelines. Results were compared to 2016 data of the same readers evaluating the same mammograms using 4th-ed guidelines after a training module. 5th-ed density categorization by seven junior BIR (1–5 years’ experience) was compared to eight experienced BIR. Nelson et al.’s kappas (Km,Kw), Fleiss’ KF, and Cohen’s K were calculated. Quantitative density using Volpara was compared with reader assessments. Inter-reader weighted agreement using 5th-ed is moderately strong, 0.73 (Kw, s.e.= 0.01), similar to 4th-ed, 0.71 (Kw, s.e.= 0.03). Intra-reader Cohen’s k is 0.23–0.34, similar to 4th-ed. Binary not-dense vs dense categorization, using 5th-ed results in higher dense categorization vs 4th-ed (p<0.001). 5th-ed density distribution results in higher numbers in categories B/C vs 4th-ed (p<0.001). Distribution for 5th-ed does not differ based on reader experience (p=0.09). Reader vs quantitative weighted agreement is similar (5th-ed, Cohen’s k= 0.76–0.85; 4th-ed, Cohen’s k =0.68–0.83). There is persistent subjectivity of visually assessed mammographic density using 5th-ed guidelines; experience does not correlate with better inter-reader agreement.
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