Automated, Clinical BI-RADS Equal in Predicting Interval, Screen-Detected Breast Cancer Risk

Automated and clinical BI-RADS density are equal in predicting interval and screen-detected cancer risk, according to a study published in the Annals of Internal Medicine.

Researchers from California, Minnesota, New Mexico and Hawaii sought to determine if breast cancer risk and detection were similar for automated and clinical BI-RADS density measures.

The study included 1,609 women with screen-detected cancer, 351 women with interval invasive cancer, and 4,409 matched control participants. All underwent automated and clinical BI-RADS density assessed on digital mammography at two time points from September 2006 to October 2014, interval and screen-detected breast cancer risk, and mammography sensitivity.

The results showed 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 and a 1.43-fold higher screen-detected risk than women 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 six months to less than two years or two to five years before diagnosis.

Automated and clinical BI-RADS density measures had similar discriminatory accuracy, which was higher for interval than screen-detected cancer. Mammography sensitivity was similar for automated and clinical BI-RADS categories:

Automated Clinical/BI-RADS

• Fatty 93% automated/92% BI-RADS
• Scattered fibroglandular densities 90%/90%
• Heterogeneously dense 82%/78%
• Extremely dense 63%/64%

The authors pointed out that neither automated nor clinical BI-RADS density was assessed on tomosynthesis.