The American College of Radiology (ACR) recently published the 5 th Edition of the Breast Imaging Reporting and Data System (BI-RADS) Atlas,
which included changes to the assessment of breast composition.
Due to the improved reproducibility compared to visual readers,
our clinic uses automated volumetric breast density (VBD) software,
and it was important to understand how the changes should impact our BI-RADS density reading.
The BI-RADS 5 th Edition clearly states that breast composition is a volumetric assessment of dense tissue.
Several other changes were made,
including: Change 1 - Using letters (i.e.
d) rather than numbers (i.e.
4) Change 2 – Removal of the quantitative area-based percentage ranges Change 3 – Suggesting increasing the density category for “breasts containing coalescent areas of fibroglandular tissue that are sufficiently dense to obscure small masses”. Figure 1...
Findings and procedure details
We reviewed Changes 1-3 as outlined in the previous section,
and how these changes might impact breast density assessment in our clinic using automated software (VolparaDensity,
Matakina Technology Ltd,
New Zealand). Change 1 – Using letters rather than numbers for the density categories The manufacturer of the volumetric software already allow configuration of their software to conform to either the 4 th or 5 th Edition categories.
An example clinical scorecard,
Volumetric approaches to breast density assessment are entirely consistent with the changes in the BI-RADS 5 th Edition,
provided that the software is configured to use the denser breast for the final density score. In our population,
use of the denser breast will result in a slight increase (approximately 4%) in the number of women re-classified as “Dense”,
and is an important consideration in resource allocation for supplementary imaging.
Professor André-Robert Grivegnée,
PhD Cancer Screening and Prevention,
Institute Jules Bordet,
 American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) Atlas 5 th ed.