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Dutch Researchers Compare BI-RADS 5th Edition Breast Density Scores to Automated Volumetric Breast Density in a Clinical Setting

Researchers from the Netherlands recently completed a study comparing BI-RADS 5th Edition visual breast density scores to VolparaDensity's continuous, quantitative measure of volumetric breast density and VolparaDensity's automated BI-RADS score. Results of the study, “Comparing Visually Assessed BI-RADS Breast Density and Automated Volumetric Breast Density Software: A Cross-Sectional Study in a Breast Cancer Screening Setting,” recently published (DOI:10.1371/journal.pone.0136667), suggest that volumetric density measures may potentially be used in the evaluation of screening performance and to identify risk groups.

“The use of automated volumetric density measures has been advocated in several studies and the results suggest that volumetric density has several advantages over qualitative scales and area-based density measures, including the calculation of breast density based on 3D instead of 2D information. This estimate of the actual volume of the tissue rather than the 2D projection of the tissue is expected to have a stronger biological association,” said Gerard J. den Heeten, co-author and recently retired chair of the LRCB Dutch Reference Center for Screening, Nijmegen, The Netherlands.

The objective of the study was to compare different methods for measuring breast density, both visual assessments and automated volumetric density, in a breast cancer screening setting. The study included 992 digital mammographic exams of women participating in the Dutch breast cancer screening programme. Following a consensus meeting to ensure readers were interpreting the American College of Radiology BI-RADS 5th edition lexicon consistently, three experienced radiologists provided a 5th edition density score for each study. The final reader score was based on agreement by at least two readers (or the median read if all three readers disagreed). Breast density was also measured using VolparaDensity and categorized using the Volpara Density Grades (VDG), which are analogous to the BI-RADS density categories.

“Consistent with other studies using BI-RADS density classifications, we observed significant variability among the radiologists. However, there was a positive association between percent dense volume and the BI-RADS density scale and the Volpara Density Grades seemed to be a good approximation of BI-RADS density in our study. This reinforces the conclusion that automated, volumetric density measures may potentially be used in the evaluation of screening performance and to identify risk groups,” added Heeten.

Results of the study demonstrate that the inter-reader agreement between radiologists ranged from weighted kappa = 0.8 - 0.84 and the intra-reader agreement ranged from weighted kappa = 0.82 - 0.87. Both the volumetric breast density and the absolute dense volume reported by VolparaDensity increased with increasing visual BI-RADS categories. VolparaDensity's automated BI-RADS showed a substantial agreement with the visual BI-RADS scores with a weighted kappa = 0.80. Based on these results, the authors noted that volumetric density measures may potentially be used in the evaluation of screening performance and to identify risk groups.

“As research continues to demonstrate the impact of breast density in mammographic sensitivity and as a risk factor for breast cancer, it is becoming increasingly important to demonstrate consistency in measurement across a screening program. The ability to analyze breast density using a method consistent with the BI-RADS scale that radiologists are familiar with while reducing the inherent variability is a significant step in accomplishing that goal,” said Ralph Highnam, Ph.D., CEO, Volpara Solutions.

About Volpara Solutions
Founded with the goal of helping radiologists give women the most accurate information possible regarding their breast health, Volpara Solutions is the wholly owned sales and marketing arm of Volpara Health Technologies Limited of New Zealand (formerly Matakina Technology). Cleared by the FDA, HealthCanada, the TGA, and CE-marked, VolparaDensity provides an objective volumetric measure of breast density from digital mammography. VolparaDensity is part of a suite of quantitative breast imaging tools built on the Volpara Solutions algorithm that allows for personalized measurements of density, patient-specific x-ray dose, breast compression and other factors designed to provide critical insight for breast imaging workflow. For more information, visit

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