Association of Volumetric Breast Density with Clinical and Histopathological Factors in 205 Breast Cancer Patients

Nari Jung; Won Hwa Kim

doi:10.3348/jksr.2018.79.1.18

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Jung and Kim: Association of Volumetric Breast Density with Clinical and Histopathological Factors in 205 Breast Cancer Patients

Original Article

J Korean Soc Radiol 2018;79(1):18-26.

Published online: 19 January 2018

DOI: https://doi.org/10.3348/jksr.2018.79.1.18

Association of Volumetric Breast Density with Clinical and Histopathological Factors in 205 Breast Cancer Patients

Nari Jung, MD, Won Hwa Kim, MD

Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea

Corresponding author: Won Hwa Kim, MD Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, 807 Hoguk-ro, Buk-gu, Daegu 41404, Korea. Tel. 82-53-200-2527 Fax. 82-53-200-3349 E-mail: greenoaktree9@gmail.com

Received 28 July 2017 Revised 18 October 2017 Accepted 7 March 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the association of volumetric breast density with clinicopathological factors in breast cancer patients.

Materials and Methods:

A total of 205 Korean patients with breast cancer who underwent mammography for initial staging between January 2015 and June 2016 were enrolled. Volumetric breast density was measured using a fully automated commercial method (Volpara^®). in the contralateral breast. The association of volumetric breast density with clinical and histopathological factors was evaluated using t-test and analysis of variance asappropriate.

Results:

Mean volumetric breast density in all patients was 13.5% (range, 4.1–34.9%). The mean volumetric breast density in patients with symptom-detected cancers was significantly higher than that in those with screening-detected cancers (14.9% vs. 11.8%, p = 0.002). Mean volumetric breast density tended to decrease with age (20–39 years: 19.0%, 40–59 years: 14.3%, 60–80 years: 7.7%). The mean volumetric breast density in postmenopausal women was significantly lower than that in premenopausal women (9.8% vs. 17.6%, p < 0.001). Other histopathological factors including histologic grade or hormone receptor status were not associated with volumetric breast density.

Conclusion:

Our results suggest that volumetric breast density is associated with the method of detection, age, and menopausal status.

Keywords: Breast Cancer, Mammography, Breast Density

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Fig. 1

Right (A) and left (B) craniocaudal mammograms in 49-year-old woman diagnosed with breast cancer for palpable mass in her left inner breast. A fully automated software (Volpara; Volpara Health Technologies, Wellington, the New Zealand) for volumetric breast density assessment shows that the percentage mammographic density of her right breast is 24.9% (Volpara-assigned BI-RADS grade d). Two radiologists assessed BI-RADS grade d for visual assessment in consensus. BI-RADS = Breast Imaging Reporting and Data System

Fig. 2

Right (A) and left (B) craniocaudal mammograms in 60-year-old woman diagnosed with breast cancer patient detected in health screening in the left mid outer breast. A fully automated software (Volpara; Volpara Health Technologies, Wellington, the New Zealand) for volumetric breast density assessment shows that the percentage mammographic density of her right breast is 4.5% (Volpara-assigned BI-RADS grade b). Two radiologists assessed BI-RADS grade c for visual assessment in consensus. BI-RADS = Breast Imaging Reporting and Data System

Table 1.

Association of Breast Volume, FGT Volume, and Volumetric Breast Density with Clinical Factors in 205 Breast Cancer Patients

	Breast Volume (cm³)	p-Value	FGT Volume (cm³)	p-Value	Breast Density (%)	p-Value
Age, years		0.124		0.001		< 0.001
20–39 (n = 23)	459.4 (395.9)		68.4 (38.7)		19.0 (8.2)
40–59 (n = 142)	487.1 (236.4)		64.5 (38.3)		14.3 (6.5)
60–80 (n = 40)	573.7 (228.6)		41.8 (19.7)		7.7 (3.4)
Method of detection		0.271		0.078		0.002
Screening (n = 90)	523.4 (232.2)		55.5 (31.1)		11.8 (5.9)
Symptom (n = 115)	483.3 (277.3)		64.3 (40.0)		14.9 (7.5)
Family history of breast cancer		0.201		0.359		0.431
Absent (n = 191)	507.2 (258.7)		60.9 (37.3)		13.4 (7.1)
Present (n = 14)	414.0 (251.4)		54.2 (24.8)		14.9 (6.2)
Menopausal status		0.130		< 0.001		< 0.001
Premenopausal (n = 98)	472.1 (274.7)		75.2 (40.0)		17.6 (6.7)
Postmenopausal (n = 107)	527.2 (241.3)		47.0 (26.8)		9.8 (4.9)
HRT experience		0.561		0.699		0.542
Absent (n = 174)	496.6 (261.8)		60.0 (36.4)		13.7 (7.1)
Present (n = 31)	524.7 (242.8)		62.9 (38.0)		12.9 (6.6)
Parity		0.307		0.022		0.183
Nulliparous (n = 27)	560.8 (332.0)		75.0 (33.4)		15.2 (6.6)
Parous (n = 178)	491.8 (245.5)		58.3 (36.6)		13.3 (7.1)
Type of breast surgery		0.077		0.633		0.499
Breast-conserving (n = 163)	517.1 (270.1)		58.1 (35.6)		14.2 (7.0)
Mastectomy (n = 42)	437.9 (198.9)		61.1 (2.9)		13.4 (7.0)

Data are mean values, with standard deviations in parenthesis. FGT = fibroglandular tissue, HRT = hormone replacement therapy

Table 2.

Association of Breast Volume, FGT Volume, and Volumetric Breast Density with Histopathological Factors in 205 Breast Cancer Patients

	Breast Volume (cm³)	p-Value	FGT Volume (cm³)	p-Value	Breast density (%)	p-Value
Histologic type		0.754		0.259		0.736
Invasive ductal carcinoma (n = 165)	498.0 (244.0)		60.1 (35.9)		13.7 (7.3)
DCIS (n = 17)	480.6 (396.9)		51.3 (29.1)		12.3 (5.6)
Others (n = 23)	536.8 (245.4)		70.1 (44.8)		13.5 (5.7)
Histologic grade∗		0.016		0.093		0.465
Low (n = 23)	645.4 (403.8)		76.6 (47.5)		13.8 (7.5)
Intermediate (n = 110)	472.6 (243.6)		60.4 (34.4)		14.3 (7.1)
High (n = 55)	488.8 (215.2)		56.8 (37.7)		12.9 (7.1)
Lymphovascular invasion∗		0.344		0.604		0.154
Absent (n = 133)	513.6 (251.1)		62.2 (40.4)		13.2 (6.7)
Present (n = 55)	476.5 (225.4)		59.1 (27.7)		14.8 (8.1)
Hormone receptor status		0.442		0.492		0.976
Negative (n = 58)	480.6 (220.0)		57.8 (33.1)		13.5 (6.9)
Positive (n = 147)	208.9 (272.7)		61.5 (37.9)		13.6 (7.1)
HER2 status		0.126		0.699		0.185
Negative (n = 169)	511.3 (270.0)		60.0 (35.7)		13.2 (6.7)
Positive (n = 36)	452.2 (192.3)		62.8 (40.7)		15.2 (8.1)
Tumor size∗		0.487		0.280		0.515
≤ 2 cm (n = 134)	494.8 (241.1)		59.5 (37.0)		13.4 (7.0)
> 2 cm (n = 54)	522.3 (251.6)		65.9 (37.1)		14.2 (7.4)
Axillary nodal status		0.632		0.109		0.235
Negative (n = 159)	496.2 (259.9)		58.3 (34.3)		13.2 (6.8)
Positive (n = 46)	517.0 (256.5)		68.1 (42.8)		14.6 (7.8)

Data are mean values, with standard deviations in parenthesis.

∗Patients with only invasive carcinoma (n = 188).

DCIS = ductal carcinoma in situ, FGT = fibroglandular tissue, HER2 = human epidermal growth factor receptor 2

Table 3.

Association of Breast Density Assessed Visually and Assigned by Volpara with Clinical Factors in 205 Patients

	Visual BI-RADS	p-Value	Volpara-Assigned BI-RADS	p-Value
Age, years		< 0.001		< 0.001
20–39 (n = 23)	3.3 (0.6)		3.5 ± 0.7
40–59 (n = 142)	3.1 ± 0.5		3.2 ± 0.8
60–80 (n = 40)	2.6∗ (0.7)		2.5 ± 0.6∗
Method of detection		0.013		0.034
Screening (n = 90)	2.9 ± 0.5		3.0 ± 0.8
Symptom (n = 115)	3.1 ± 0.6		3.2 ± 0.8
Family history of breast cancer		0.315		0.240
Absent (n = 191)	3.0 ± 0.6		3.1 ± 0.8
Present (n = 14)	3.1 ± 0.5		3.4 ± 0.6
Menopausal status		< 0.001		< 0.001
Premenopausal (n = 98)	3.2 ± 0.5		3.6 ± 0.6
Postmenopausal (n = 107)	2.7 ± 0.6		2.7 ± 0.7
Hormone replacement therapy experience		0.414		0.280
Absent (n = 174)	3.0 ± 0.6		3.1 ± 0.8
Present (n = 31)	2.9 ± 0.8		3.0 ± 0.9
Parity		0.066		0.203
Nulliparous (n = 27)	3.2 ± 0.5		3.3 ± 0.7
Parous (n = 178)	3.0 ± 0.6		3.1 ± 0.8
Type of breast surgery		0.457		0.178
Breast-conserving (n = 163)	3.0 ± 0.6		3.1 ± 0.8
Mastectomy (n = 42)	3.0 ± 0.5		3.3 ± 0.7

Data are mean values, with standard deviations in parenthesis. ∗p< 0.05 for groups with 20–39 years and 40–59 years.

BI-RADS = Breast Imaging Reporting and Data System

Table 5.

Volumetric Density Grade by the Method of Detection of Breast Cancer

	Screening-Detected (n = 90)	Symptom-Detected (n = 115)
Volpara-assigned (%)
a	0	2 (1.7)
b	30 (33.3)	20 (17.4)
c	32 (35.6)	44 (38.3)
d	28 (31.1)	49 (42.6)
Visual (%)
a	1 (1.1)	2 (3.5)
b	17 (18.9)	7 (6.1)
c	65 (72.2)	80 (69.6)
d	7 (7.8)	24 (20.9)

For Volpara-assigned density, the quantitative volumetric breast density is mapped to an automated density scale (Volpara Density Grade) using the VolparaDensity software (Volpara Health Technologies, Wellington, the New Zealand). The threshold for grade a, b, c, and d was 0.0–4.5%, 4.5–7.5%, 7.5–15.5%, and ≥ 15.5% (in percent dense volume), respectively. Visual density was assessed based on American College of Radiology Breast Imaging Reporting and Data System four category system 4th edition (1: almost entirely fatty, 2: scattered fibroglandular densities, 3: heterogeneously dense, and 4: extremely dense) (9).

Table 4.

Association of Breast Density Assessed Visually and Assigned by Volpara with Histopathological Factors in 205 Patients

	Visual BI-RADS	p-Value	Volpara-Assigned BI-RADS	p-Value
Histologic type		0.968		0.836
Invasive ductal carcinoma (n = 165)	3.0 ± 0.6		3.1 ± 0.8
DCIS (n = 17)	3.0 ± 0.4		3.0 ± 0.7
Others (n = 23)	3.0 ± 0.6		3.1 ± 0.8
Histologic grade∗		0.992		0.440
Low (n = 23)	3.0 ± 0.3		3.1 ± 0.8
Intermediate (n = 110)	3.0 ± 0.6		3.2 ± 0.8
High (n = 55)	3.0 ± 0.7		3.0 ± 0.9
Lymphovascular invasion∗		0.291		0.301
Absent (n = 133)	3.0 ± 0.6		3.1 ± 0.8
Present (n = 55)	2.9 ± 0.7		3.2 ± 0.8
Hormone receptor status		0.769		0.923
Negative (n = 58)	3.0 ± 0.5		3.1 ± 0.8
Positive (n = 147)	3.0 ± 0.7		3.1 ± 0.8
HER2 status		0.645		0.368
Negative (n = 169)	3.0 ± 0.6		3.1 ± 0.8
Positive (n = 36)	3.0 ± 0.7		3.2 ± 0.8
Tumor size		0.287		0.784
≤ 2 cm (n = 134)	3.0 ± 0.6		3.1 ± 0.8
> 2 cm (n = 54)	2.9 ± 0.7		3.1 ± 0.9
Axillary nodal status		0.462		0.426
Negative (n = 159)	3.0 ± 0.6		3.1 ± 0.8
Positive (n = 46)	3.0 ± 0.6		3.2 ± 0.8

∗Patients with only invasive carcinoma (n = 188).

BI-RADS = Breast Imaging Reporting and Data System, DCIS = ductal carcinoma in situ, HER2 = human epidermal growth factor receptor 2

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