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Assessment of the Severity of Breast Artery Calcification on a Mammogram: Intraoperator and Interoperator Reproducibility

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Purpose. To study approaches to the quantitative assessment of breast arterial calcification (BAC) – a new surrogate marker of high cardiovascular risk in women, to determine the most detailed way to quantify BAC and to assess the reproducibility of these parameters.

Material and methods. Mammograms of 1,078 women were analyzed for the presence of BAC. The intraoperator reproducibility of the assessment of the severity of BAC using a 12-point scale (Margolies L et al., 2016) was studied by analyzing 20 mammograms by the same operator twice with an interval of at least 2 weeks. Inter-operator reproducibility was studied by analyzing 99 mammograms by two independent operators.

Results. When assessing the intraoperative reproducibility of the total score for each mammary gland, the exact coincidence of the results was noted in 70% (95% confidence interval [CI] 53.5-83.4), in cases of difference of no more than 1 point – in 27.5% (95%CI 14.6-43.9), only in 1 case the difference in assessments was 2 points. No systematic error was found between the two measurements (p=1.0), the correlation coefficient was rs=0.973. The assessment of inter-operator reproducibility showed that the exact coincidence of indicators was present in 48.5% (95%CI 41.3-55.7), in 91.4% (95% CI 86.6-94.9) cases, the total score for each the mammary gland differed by no more than 1 point. There was no systematic error between the measurements of the two experts (p=0.438), the correlation coefficient was rs=0.942.

Conclusion. A good intraoperator and interoperator reproducibility of indicators of the severity of BAC on a 12-point scale has been shown, which makes it possible to recommend it for use in science and practice.

About the Authors

E. V. Bochkareva
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Elena V. Bochkareva


E. K. Butina
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Ekaterina K. Butina

Moscow, eLibrary SPIN 1170-0594

N. Kh. Bayramkulova
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Nyurdzhan Kh. Bayramkulova


O. A. Abdalova
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Olga V Abdalova


V. A. Kutsenko
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Vladimir A. Kutsenko

Moscow, eLibrary SPIN 8567-1789

O. M. Drapkina
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Oxana M. Drapkina

Moscow, eLibrary SPIN 4456-1297


1. Roth GA, Abate D, Abate KH, et al. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study. Lancet. 2018;392(10159):1736-88. DOI:10.1016/S0140-6736(18)32203-7.

2. Benjamin E.J., Muntner P., Alonso A. et al. Heart disease and stroke statistics—2019 update: a report from the American Heart Association. Circulation. 2019; 139(10):e56-e528. DOI:10.1161/CIR.0000000000000659.

3. Wilmot KA, O'Flaherty M, Capewell S, et al. Coronary heart disease mortality declines in the United States from 1979 through 2011. Circulation. 2015;132(11):997-1002. DOI:10.1161/CIRCULATIONAHA.115.015293.

4. DeFilippis AP, Young R, Carrubba CJ, et al. An analysis of calibration and discrimination among multiple cardiovascular risk scores in a modern multiethnic cohort. Ann Intern Med. 2015;162:266-75. DOI:10.7326/M14-1281.

5. Bui QM, Daniels LB. A review of the role of breast arterial calcification for cardiovascular risk stratification in women. Circulation. 2019;139(8):1094-101. DOI:10.1161/CIRCULATIONAHA.118.038092.

6. Wenger NK. Transforming cardiovascular disease prevention in women: time for the Pygmalion construct to end. Cardiology. 2015;130(1):62-8. DOI:10.1159/000370018.

7. Abouzeid C, Bhatt D, Amin N. The top five women’s health issues in preventive cardiology. Curr Cardiovasc Risk Rep. 2018;12:6. DOI:10.1007/s12170-018-0568-7.

8. Cheng JZ, Chen CM, Cole EB, et al. Automated delineation of calcified vessels in mammography by tracking with uncertainty and graphical linking techniques. IEEE Trans Med Imaging. 2012;31(11):2143- 55. DOI:10.1109/TMI.2012.2215880.

9. Sickles EA, D’Orsi CJ, Bassett LW. ACR BI-RADS Mammography. In: ACR BI-RADS Atlas, Breast Imaging Reporting and Data System, 5th Edition. Reston, VA: American College of Radiology; 2013:134-136.

10. Bochkareva EV, Kim IV, Butina EK, et al. Mammographic Screening as a Tool for Cardiovascular Risk Assessing. Part 2. Association of Breast Arterial Calcification and Cardiovascular Diseases. Rational Pharmacotherapy in Cardiology. 2019;15(3):424-30 (In Russ.) DOI:10.20996/1819-6446-2019-15-3-424-430.

11. Margolies L, Salvatore M, Hecht HS, et al. Digital Mammography and Screening for Coronary Artery Disease. JACC Cardiovasc Imaging. 2016;9:350-60. DOI:10.1016/j.jcmg.2015.10.022.

12. Yoon YE, Kim KM, Han JS, et al. Prediction of Subclinical Coronary Artery Disease With Breast Arterial Calcification and Low Bone Mass in Asymptomatic Women: Registry for the Women Health Cohort for the BBC Study. JACC Cardiovasc Imaging. 2019;12(7 Pt 1):1202-11. DOI:10.1016/j.jcmg.2018.07.004.

13. Polonsky TS, Greenland P. Breast Arterial Calcification Expanding the Reach of Cardiovascular Prevention. Circulation. 2017;135(6):499-501. DOI:10.1161/CIRCULATIONAHA.116.025277.

14. Trimboli RM, Codari M, Guazzi M, Sardanelli F. Screening mammography beyond breast cancer: breast arterial calcifications as a sex-specific biomarker of cardiovascular risk. Eur J Radiol. 2019;119:108636. DOI:10.1016/j.ejrad.2019.08.005.

15. Sedighi N, Radmard AR, Radmehr A, et al. Breast arterial calcification and risk of carotid atherosclerosis: Focusing on the preferentially affected layer of the vessel wall. Eur J Radiol. 2011;79(2):250-6. DOI:10.1016/j.ejrad.2010.04.007.

16. Ahn KJ, Kim YJ, Cho HJ, et al. Correlation between breast arterial calcification detected on mammography and cerebral artery disease. Arch Gynecol Obstet. 2011;284(4):957-64. DOI:10.1007/s00404-010-1742-4.

17. Kemmeren M, van Noord PA, Beijerinck D, et al. Arterial calcification found on breast cancer screening mammograms and cardiovascular mortality in women the DOM Project. Am J Epidemiol. 1998;147(4):333-41. DOI:10.1093/oxfordjournals.aje.a009455.

18. Yildiz S, Yildiz A, Ertug N, et al. Association of breast arterial calcification and carotid intima-media thickness. Heart Vessels. 2008;23(6):376-82. DOI:10.1007/s00380-008-1058-5.

19. Sarrafzadegann N, Ashrafi F, Noorbakhsh M, et al. Association of breast artery calcification with coronary artery disease and carotid intima-media thickness in premenopausal women. East Mediterr Health J. 2009;15(6):1474-82.

20. Maas AHEM, van der Schouw YT, Mali WPThM, van der Graaf Y. Progression of calcifications in breast arteries in women at high risk for coronary heart disease events. Neth Heart J. 2006;14(9):287-91.

21. Sankaran PP, Rao P, Koteshwara P. Association of vascular calcification of breast with carotid intima media thickness. Pol J Radiol. 2019;84:e335-e339. DOI:10.5114/pjr.2019.88064.

22. Büyükkaya R, Büyükkaya A, Altunkaşet A, et al. Breast arterial calcifications and carotid-intima thickness and heamodynamics: Is there any association? Anadolu Kardiyol Derg. 2014;14(4):378-82. DOI:10.5152/akd.2014.4705.

23. Erdogmus B, Büyükkaya R, Büyükkaya A, Yazıcı B. Relationship between breast arterial calcifications detected on mammography and brachial artery intima-media thickness. Wien Klin Wochenschr. 2013;125(3-4):100-4. DOI:10.1007/s00508-013-0322-6.

24. Mostafavi L, Marfori W, Arellano C, et al. Prevalence of coronary artery disease evaluated by coronary CT angiography in women with mammographically detected breast arterial calcifications. PLoS One. 2015;10(4):e0122289. DOI:10.1371/journal.pone.0122289.

25. Yağtu M. Evaluating the Association between Breast Arterial Calcification and Carotid Plaque Formation. J Breast Health. 2015;11(4):180-5. DOI:10.5152/tjbh.2015.2544.

26. Ruzicic D, Dobric M, Vukovic M, et al. The correlation of SYNTAX score by coronary angiography with breast arterial calcification by digital mammography. Clin Radiol. 2018;73(5):454-9. DOI:10.1016/j.crad.2017.12.002.

27. Kelly BS, ScanlON E, Heneghan H, et al. Breast Arterial Calcification on screening mammography can predict significant Coronary Artery Disease in women. Clin Imaging. 2018;49:48-53.DOI:10.1016/j.clinimag.2017.10.021.

28. Trimboli RM, Capra D, Codari M, et al. Breast arterial calcifications as a biomarker of cardiovascular risk: radiologists' awareness, reporting, and action. A survey among the EUSOBI members. Eur Radiol. 2021;31(2):958-66. DOI:10.1007/s00330-020-07136-6.

29. Margolies LR, Yip R, Hwang E, et al. Breast arterial calcification in the mammogram report: the patient perspective. Am J Roentgenol. 2019;212(1):209-14. DOI:10.2214/AJR.18.20171.

For citation:

Bochkareva E.V., Butina E.K., Bayramkulova N.K., Abdalova O.A., Kutsenko V.A., Drapkina O.M. Assessment of the Severity of Breast Artery Calcification on a Mammogram: Intraoperator and Interoperator Reproducibility. Rational Pharmacotherapy in Cardiology. 2021;17(5):688-695. (In Russ.)

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ISSN 1819-6446 (Print)
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