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Women with mammograms that radiologists classify as dense have been found to have an increased risk of breast cancer. The purpose to this investigation was to determine whether human readers are willing and able to make reliable comparisons of five attributes of pairs of mammograms matched by a quantitative estimate of the fraction of dense tissue (FDT). Forty pairs of CC projections were digitized and presented using a computer workstation. The 40 pairs of mammograms had the same FDT as measured by a visual threshold procedure. Each breast image was from a different woman. The difference in the following 5 attributes were rated: (1) fraction of dense tissue, (2) fraction of homogeneous of the dense tissue, (3) fraction of ductal dense tissue, (4) prominence of scalloping of dense tissue, and (5) prominence of subareolar structures. The rating were replicated to evaluate their reliability. Spearman rank-order correlations of replicated measurements ranged from 0.89 to 0.65 (p was less than 0.0001). Homogeneous dense tissue ratings were negatively correlated with ductal dense tissue ratings (-0.59, p equals 0.0001). The prominence of scalloping rating was not significantly correlated with other attributes. The ratings of the attributes, except scalloping, were significantly correlated to differences mean gray level of breast parenchyma. Readers can make reliable judgments regarding the differences in attributes of mammograms that are matched by FDT. The negative correlation between the homogeneous dense and the ductal dense tissue ratings suggest that homogeneous dense and ductal dense tissues contend for perceived dense breast area. The absence of correlation between scalloping and other image attributes suggests further investigation of scalloping as an independent, breast-cancer risk factor is warranted.
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