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Reliability of Computer-Assisted Breast Density Estimation: Comparison of Interactive Thresholding, Semiautomated, and Fully Automated Methods
미국 영상의학회지 Reliability of Computer-Assisted Breast Density Estimation: Comparison of Interactive Thresholding, Semiautomated, and Fully Automated Methods 2016.07.10.
American Journal of Roentgenology. 2016;207: 126-134. 10.2214 논문 보기
Materials and Methods
Craniocaudal mammograms of 100 healthy subjects were collected from a screening mammography database. Three expert readers independently assessed mammographic breast density twice in a 1-month period using interactive thresholding and semiautomated methods. In addition, fully automated breast density estimation software was used to generate objective breast density estimates. The reliability of the computer-assisted breast density estimation was assessed in terms of concordance correlation coefficients, limits of agreement, systematic difference, and reader variability.

Results
Statistically significant systematic bias (paired t test, p < 0.01) and variability (4.75–10.91) were found within and between readers for both the interactive thresholding and the semiautomated methods. Using the semiautomated method significantly reduced the within-reader bias of one reader (p < 0.02) and the between-reader variability of all three readers (p < 0.05). The breast density estimates obtained with the fully automated method had excellent agreement with those of the reference standard (concordance correlation coefficient, 0.93) without a significant systematic difference.

Conclusions
Reader-dependent variability and systematic bias exist in breast density estimates obtained with the interactive thresholding method, but they may be reduced in part by use of the semiautomated method. Assessing reader performance may be necessary for more reliable breast density estimation, especially for surveillance of breast density over time. The fully automated method has the potential to provide reliable breast density estimates nearly free from reader-dependent systematic bias and reader variability.

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