Image evaluation and breast density categories as a function of mammary positioning in full-field digital mammography

Background Appropriate mammary positioning is an important factor in optimizing image quality in mammography (MMG). Purpose To study the correlation of quality criteria and breast density classification proposed by the American College of Radiology (ACR) and European Guidelines and its influence to achieve a proper positioning, therefore an adequate MMG. Material and methods A total of 128 routine MMG examinations were reviewed for the definition of breast composition parenchyma and assessment of several quality criteria proposed by the ACR and European Guidelines to achieve an adequate MMG. Adequate MMG was defined as a difference between the posterior nipple line (PNL), difference of the mediolateral oblique (MLO) and craniocaudal (CC) incidences > 1 cm. The quality criteria were analyzed as a function of correlation coefficient in order to evaluate the individual impact of each factor and analysis of variance (ANOVA) for all criteria. Receiver operating characteristic (ROC) curves were plotted to evaluate the performance of the criteria on each type of parenchyma. Results Negative correlation of fatty breasts and visibility of the mammary angle, a greater number of skin folds and PNL > 1 cm (r < 0). Dense MMG presented less visibility of the lateral tissue compared with other categories. Area under the curve of ROC analysis revealed values of 53.1% and 54.7% for the right and left breasts, respectively. Conclusion Several factors influenced in the MMG process, but we find that breast parenchyma has a substantial role in affecting these criteria and therefore a correct position for diagnosis, which could compromise MMG diagnostic performance.