Agreement of Breast Nodularity on Clinical Examination and Mammographic Density

Background: Breast density is routinely reported on mammograms, while breast nodularity is seldom reported on clinical examination, and there is no standard system for its classification. Objectives: The aim of this study was to evaluate the agreement of mammographic density with nodularity on clinical breast examination (CBE). In addition, the relationship of mammographic density with age, menopausal status, and number of parities were assessed.                      Methods: This cross‑sectional study was conducted from September 2013 to February 2014, on 30–70‑year‑old women who referred for screening or diagnostic mammography to Shahid Beheshti Hospital, Kashan, Iran. Nodule size, nodule consistency, and mammographic density were assessed, and Cohen’s kappa coefficient was calculated. The Chi‑square test was also used to assess the relationship of mammographic density with age, menopausal status, and a number of parities. Results: In this study, 320 women with an age mean value of 46.01 ± 7.73 underwent mammography and CBE. Mammographic density showed a statistically significant weak agreement with nodule size (Kappa coefficient = 0.275; P < 0.001) and nodule consistency (Kappa coefficient = 0.256; P < 0.001). Moreover, mammographic density was inversely related to age, menopausal status, and number of parities (P < 0.001).                                                                  Conclusions: Breast nodularity on clinical examination has only a weak agreement with mammographic density. Further studies are needed to develop more comprehensive instruments for assessing not only nodule size and consistency but also nodules distribution in all breast quadrants.