Estimation of percentage breast tissue density: comparison between digital mammography (2D full field digital mammography) and digital breast tomosynthesis according to different BI-RADS categories

Objective: To compare breast density estimated from two-dimensional full-field digital mammography (2D FFDM) and from digital breast tomosynthesis (DBT) according to different Breast Imaging-Reporting and Data System (BI-RADS) categories, using automated software. Methods: Institutional review board approval and written informed patient consent were obtained. DBT and 2D FFDM were performed in the same patients to allow within-patient comparison. A total of 160 consecutive patients (mean age: 50614 years; mean body mass index: 2263) were included to create paired data sets of 40 patients for each BI-RADS category. Automatic software (MedDensity©, developed by Giulio Tagliafico) was used to compare the percentage breast density between DBT and 2D FFDM. The estimated breast percentage density obtained using DBT and 2D FFDM was examined for correlation with the radiologists' visual BI-RADS density classification. Results: The 2D FFDM differed from DBT by 16.0% in BIRADS Category 1, by 11.9% in Category 2, by 3.5% in Category 3 and by 18.1% in Category 4. These differences were highly significant (p,0.0001). There was a good correlation between the BI-RADS categories and the density evaluated using 2D FFDM and DBT (r50.56, p,0.01 and r50.48, p,0.01, respectively). Conclusion: Using DBT, breast density values were lower than those obtained using 2D FFDM, with a non-linear relationship across the BI-RADS categories. These data are relevant for clinical practice and research studies using density in determining the risk. Advances in knowledge: On DBT, breast density values were lower than with 2D FFDM, with a non-linear relationship across the classical BI-RADS categories.