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Jeon, Kim, Kim, Son, Youk, Kwak, and Choi: Interobserver Variability in the Interpretation of Microcalcifications in Digital Magnification Mammographies
Breast Radiology
Original Article

Journal of the Korean Society of Radiology 2010; 63(4): 383-389.

Published online: 31 October 2010

DOI: https://doi.org/10.3348/jksr.2010.63.4.383

Interobserver Variability in the Interpretation of Microcalcifications in Digital Magnification Mammographies

Su Jin Jeon, M.D., Min Jung Kim, M.D.2, Eun-Kyung Kim, M.D.2, Eun Ju Son, M.D.2, Ji Hyun Youk, M.D.2, Jin Young Kwak, M.D.2, Seon Hyeong Choi, M.D.2

1Department of Radiology, National Health Insurance Corporation Ilsan Hospital, Korea.

2Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Korea.

Address reprint requests to: Min Jung Kim, M.D., Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, Korea. Tel. 82-2-2228-7400, Fax. 82-2-393-3035, mines@yuhs.ac

Received 31 December 2009       Accepted 2 August 2010

Copyright © 2010 The Korean Society of Radiology

Abstract

Purpose

To analyze the interobserver variability of radiologists in their description and final assessment categories of microcalcifications in digital magnification mammographies.

Materials and Methods

From 2005 to 2006, five radiologists analyzed 66 lesion microcalcifications in 65 patients on digital magnification mammographies using a blind method and including 40 benign and 26 malignant lesions. Each observer evaluated the microcalfication morphology, distribution, and BIRADS® category. Using the kappa value, the degree of interobserver agreement was calculated and the rate of malignancy was assessed.

Results

The mean kappa value for microcalcification morphology was 0.19, which was considered to be moderate agreement for the microcalcification distribution (k: 0.54). The overall rate of malignancy was 39% for microcalcification morphology and distribution. Among them, amorphous microcalcifications showed the lowest rate of malignancy (17%). The mean kappa value for the final assessment categories of BI-RADS® was 0.29 and the mean rate of malignancy was 39%.

Conclusion

Although there was slight interobserver variability, according to each of the descriptors, the general interobserver agreement in interpretation of microcalcification on digital magnification mammogram was slight to moderate. To improve interobserver agreement for the interpretation of microcalcifications, proper image quality control, standardization of criteria, and proper training of radiologists are needed.

Keywords: Observer Variation, Mammography, Calcinosis

Figures and Tables

Table 1

Interobserver Agreement in Description of Microcalcification

jksr-63-383-i001

Note.─ Benign including skin, vascular, coarse, large rod-like, round, lucent-centered, egg-shell, milk of calcium, suture, dystrophic, punctate microcalcification ; High probability of malignancy including fine pleomorphic, linear/branching microcalcification

Table 2

Diagnostic Evaluation and Correlation with Final Assessment Categorization of Microcalcification

jksr-63-383-i002

Note.─ *Benign microcalcification including 20 cases of punctuate, 2 cases of lucent-centered, 1 case of large rod like and 1 case of dys trophic microcalcification

†2 cases including regional punctuated microcalcification and linear dystrophic microcalcification

Table 3

Interobserver Agreement in Final Assessment Categorization of Microcalcification

jksr-63-383-i003

Note.─ * 13 cases including 8 cases of amorphous, 2 cases of coarse heterogenous, and 6 lesions of clusted distribution

Table 4

Results of Published Series of Interobserver Variability on Mammogram

jksr-63-383-i004

Note.─ * 13 findings including lobulated mass, asymmetric breast parenchyma, nipple retraction, skin thickening, axillary lymph node, speculated mass, indistinct marginated mass, cooper's ligament thickening, intramammary lymph node, duct ectasia, architectural distortion, stellate mass

†8-12 cases in the mass

‡NA: not assessable

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