Studies of parenchymal texture added to mammographic breast density and risk of breast cancer: a systematic review of the methods used in the literature

This systematic review aimed to assess the methods used to classify mammographic breast parenchymal features in relation to prediction of future breast cancer including the time from mammogram to diagnosis of breast cancer, and methods for the identification of texture features and selection of features for inclusion in analysis. The databases including Medline (Ovid) 1946-, Embase.com 1947-, CINAHL Plus 1937-, Scopus 1823-, Cochrane Library (including CENTRAL), and Clinicaltrials.gov . were searched through October 2021 to extract published articles in English describing the relationship of parenchymal texture features with risk of breast cancer. Twenty-eight articles published since 2016 were included in the final review. Of these, 7 assessed texture features from film mammograms images, 3 did not report details of the image used, and the others used full field mammograms from Hologic, GE and other manufacturers. The identification of parenchymal texture features varied from using a predefined list to machine-driven identification. Reduction in number of features chosen for analysis in relation to cancer incidence then varied across statistical approaches and machine learning methods. The variation in approach and number of features identified for inclusion in analysis precluded generating a quantitative summary or meta-analysis of the value of these to improve predicting risk of future breast cancers. This updated overview of the state of the art revealed research gaps; based on these, we provide recommendations for future studies using parenchymal features for mammogram images to make use of accumulating image data, and external validation of prediction models that extend to 5 and 10 years to guide clinical risk management. By following these recommendations, we expect to improve risk classification and risk prediction for women to tailor screening and prevention strategies to level of risk.