ESPE Abstracts (2018) 89 P-P2-312

Ultrasound Assessment of Pubertal Breast Development: Intra- and Inter-Observer Agreement

Ingvild Bruseruda,b, Roelants Mathieuc, Ninnie Oehmea,b, Geir Egil Eidea,b, Robert Bjerknesa,b, Karen Rosendahla,b & Pétur Júíliussona,b


aUniversity of Bergen, Bergen, Norway; bHaukeland University Hospital, Bergen, Norway; bUniversity of Leuven, KU Leuven, Belgium


Background: Clinical assessment of pubertal breast development using Tanner staging is subjective. This has led to the introduction of ultrasound, aiming for a more objective analysis. However, information regarding its reliability is lacking.

Objective: To examine intra- and inter-observer agreement of breast maturity staging using ultrasound, 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 ultrasound to score the glandular maturity stage at a 0-5 scale, and to measure the depth and diameter of the left breast. One of the observers repeated the examination after 20 to 35 minutes to assess intra-observer agreement. Cohen’s kappa with linear weights was used to examine intra- and inter-observer agreement of the ultrasound staging, while the measurement precision was analyzed using Bland-Altman plots and 95% limits of agreement.

Results: The agreement of ultrasound staging at a 0-5 scale was very good (kappa 0.84; 95% confidence interval (CI): 0.78, 0.91) for intra- and good (kappa 0.71; 95% CI: 0.62, 0.80) for inter-observer. Measurements of glandular depth and diameter were unbiased for one observer, but the variances were large both within and between observers.

Conclusion: Ultrasound, using a 0-5 scale, is a reliable method to stage glandular breast tissue development during puberty in healthy girls and adolescents. Direct measurements of glandular tissue is however imprecise, which limits its use in clinical practice or research.

Keywords: Pubertal staging, breast development, ultrasonography, observer agreement, measurement error

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