Leah H. Portnow, MD: Breast Density: A Continuing Conundrum

Leah H. Portnow, MD
Instructor in Radiology
Breast Imaging Division
Brigham and Women’s Hospital
Harvard Medical School

Abstract

In a retrospective review of 200 screening full field digital mammograms, the effect of BI-RADS® 5th edition (5th-ed) guidelines on inter- and intra-reader agreement regarding mammographic breast density assessment was compared to BI-RADS® 4th edition (4th-ed), before and after a 4th-ed training module. Additional analysis included comparisons of 5th-ed vs 4th-ed density category distribution and agreement between visual and quantitative assessments. Levels of reader experience in 5th-ed breast density assessment were also compared. Between 5th-ed and post-training 4th-ed assessments, inter-reader weighted agreement is moderately strong (5th-ed Nelson et al.’s κw= 0.73, 4th-ed κw= 0.73) and intra-reader weighted agreement is fair (Cohen’s κ= 0.23‒0.34). Density distribution is higher in scattered and heterogeneously dense categories with 5th-ed (p<0.001). No difference is noted based on experience level (p=0.09). Quantitative models are similar to reader assessment (5th-ed, Cohen’s κ= 0.76‒0.85; post-training 4th-ed, Cohen’s κ =0.68‒0.83). Given the persistent subjectivity of visually assessed mammographic density, we look to improvements in computer-based quantitative measurements to provide reliable density metrics.

Short Bio

I received my MD degree from the University of Florida College of Medicine in 2012, trained in radiology residency at Maimonides Medical Center in Brooklyn, NY and completed my breast imaging fellowship at Memorial Sloan Kettering Cancer Center in 2018. After my training, I joined the Brigham and Women’s Hospital, Harvard Medical School, Boston, MA as Instructor in Radiology, Breast Imaging Division. I have a strong interest in clinical research and mentoring trainees. My research interests include breast density, biopsy marker nomenclature and visibility, axillary lymph node management, correlating imaging and pathologic response to chemotherapy, and supplemental screening in intermediate-risk patients. My major contributions include peer-reviewed publications in medical journals, a book chapter, case reviews, and presentations at national and international medical conferences. I most recently published on breast biopsy marker nomenclature and visibility and have pending publications in breast density and the efficacy of imaging in palpable breast abnormalities in high risk patients. I am enthusiastic about my work and multidisciplinary collaboration to improve and individualize breast cancer care.