Ingvild Særvold Bruserud1,2, Mathieu Roelants3, Ninnie Helén Bakken Oehme4,5, Geir Egil Eide6,7, Robert Bjerknes4,5, Karen Rosendahl8,9, Pétur B Júlíusson4,5. 1. Department of Clinical Science, University of Bergen, Bergen, Norway. ingvild.servold.bruserud@helse-bergen.no. 2. Department of Pediatrics, Haukeland University Hospital, Bergen, Norway. ingvild.servold.bruserud@helse-bergen.no. 3. Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium. 4. Department of Clinical Science, University of Bergen, Bergen, Norway. 5. Department of Pediatrics, Haukeland University Hospital, Bergen, Norway. 6. Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway. 7. Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. 8. Department of Radiology, Haukeland University Hospital, Bergen, Norway. 9. Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Abstract
BACKGROUND: Clinical assessment of pubertal breast development using Tanner staging is subjective. This has led to the introduction of ultrasound (US), aiming for a more objective analysis. However, information regarding its reliability is lacking. OBJECTIVE: To examine intra- and interobserver agreement of breast maturity staging using US and to examine the precision of direct measurements of the gland. MATERIALS AND METHODS: Fifty-seven healthy girls (mean age: 10.9 years, range: 6.1 to 15.9 years) were examined independently by two observers using US of the left breast to score the glandular maturity stage on a 0-5 scale, and to measure the depth and diameter. One observer repeated the examination after 20 to 35 min to assess intra-observer agreement. Cohen's kappa with linear weights was used to examine intra- and interobserver agreement of the US staging, while the measurement precision was analyzed using Bland-Altman plots and 95% limits of agreement. RESULTS: The agreement of US staging on a 0-5 scale was very good (kappa 0.84; 95% confidence interval [CI] 0.78-0.91) for intra-observer observation and good (kappa 0.71; 95% CI 0.62-0.80) for interobserver observation. Measurements of glandular depth and diameter were unbiased for a single observer, but the variances were large both within and between observers. CONCLUSION: US using a scale from 0 to 5 is a reliable method to stage the development of glandular breast tissue during puberty in healthy girls. Measurements of glandular depth and diameter were found to be imprecise.
BACKGROUND: Clinical assessment of pubertal breast development using Tanner staging is subjective. This has led to the introduction of ultrasound (US), aiming for a more objective analysis. However, information regarding its reliability is lacking. OBJECTIVE: To examine intra- and interobserver agreement of breast maturity staging using US and to examine the precision of direct measurements of the gland. MATERIALS AND METHODS: Fifty-seven healthy girls (mean age: 10.9 years, range: 6.1 to 15.9 years) were examined independently by two observers using US of the left breast to score the glandular maturity stage on a 0-5 scale, and to measure the depth and diameter. One observer repeated the examination after 20 to 35 min to assess intra-observer agreement. Cohen's kappa with linear weights was used to examine intra- and interobserver agreement of the US staging, while the measurement precision was analyzed using Bland-Altman plots and 95% limits of agreement. RESULTS: The agreement of US staging on a 0-5 scale was very good (kappa 0.84; 95% confidence interval [CI] 0.78-0.91) for intra-observer observation and good (kappa 0.71; 95% CI 0.62-0.80) for interobserver observation. Measurements of glandular depth and diameter were unbiased for a single observer, but the variances were large both within and between observers. CONCLUSION: US using a scale from 0 to 5 is a reliable method to stage the development of glandular breast tissue during puberty in healthy girls. Measurements of glandular depth and diameter were found to be imprecise.
Authors: V Calcaterra; P Sampaolo; C Klersy; D Larizza; A Alfei; V Brizzi; F Beneventi; M Cisternino Journal: Ultrasound Obstet Gynecol Date: 2009-01 Impact factor: 7.299
Authors: Yiming Gao; Mansi A Saksena; Elena F Brachtel; Deborah C terMeulen; Elizabeth A Rafferty Journal: Eur J Radiol Date: 2015-04-27 Impact factor: 3.528
Authors: Ellen M Chung; Regino Cube; Gregory J Hall; Candela González; J Thomas Stocker; Leonard M Glassman Journal: Radiographics Date: 2009 May-Jun Impact factor: 5.333
Authors: Andre Madsen; Bjørg Almås; Ingvild S Bruserud; Ninnie Helen Bakken Oehme; Christopher Sivert Nielsen; Mathieu Roelants; Thomas Hundhausen; Marie Lindhardt Ljubicic; Robert Bjerknes; Gunnar Mellgren; Jørn V Sagen; Pétur B Juliusson; Kristin Viste Journal: J Clin Endocrinol Metab Date: 2022-06-16 Impact factor: 6.134