Published online before print July 26, 2002, 10.1148/radiol.2243011626
(Radiology 2002;224:871.)
A more recent version of this article appeared on September 1, 2002
Does Training in the Breast Imaging Reporting and Data System (BI-RADS) Improve Biopsy Recommendations or Feature Analysis Agreement with Experienced Breast Imagers at Mammography?1
Wendie A. Berg, MD, PhD,
Carl J. D’Orsi, MD2,
Valerie P. Jackson, MD,
Lawrence W. Bassett, MD,
Craig A. Beam, PhD3,
Rebecca S. Lewis, MPH and
Philip E. Crewson, PhD4
1 From the Dept of Radiology (W.A.B.) and Greenebaum Cancer Ctr (W.A.B.), Univ of Maryland, 419 W Redwood St, Ste 110, Baltimore, MD 21201; Dept of Radiology, Univ of Massachusetts, Worcester, Mass (C.J.D.); Dept of Radiology, Indiana Univ School of Medicine, Indianapolis (V.P.J.); Dept of Radiological Sciences, UCLA School of Medicine, Los Angeles, Calif (L.W.B.); Dept of Radiology, Medical College of Wisconsin, Milwaukee (C.A.B.); and American College of Radiology, Reston, Va (R.S.L., P.E.C.). From the 2000 RSNA scientific assembly. Received Oct 5, 2001; revision requested Nov 1; revision received Feb 6, 2002; accepted Feb 28. Supported by the Maryland Chapter of the Susan G. Komen Breast Cancer Foundation and the American College of Radiology Technology Assessment Studies Assistance Program. Address correspondence to W.A.B. (e-mail: waberg@umaryland.edu).
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Figure 1. Graph shows Az values for each participant ( ), as compared with the consensus reference standard, before and after 1 day of BI-RADS training. The line is one of equivalence. Note that two participants performed worse after training, and two showed no change. The remaining 17 showed at least some improvement.
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Figure 2. Lateral true spot-magnification mammogram shows new pleomorphic calcifications in multiple groups (arrows) due to intermediate-grade ductal carcinoma in situ (micropapillary type) in a 50-year-old woman. The experienced breast imagers did not agree on description or management of this case, which was considered typically benign by two of them and pleomorphic by a third. After discussion, the consensus was that the calcifications were not uniformly round but rather pleomorphic and thus suggestive of malignancy. This case showed the highest variance in management of all malignancies after training, with 81% of participants describing these as typically benign or punctate and probably benign before training, and only 30% describing them as pleomorphic and suspicious even after 1 day of BI-RADS training.
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Figure 3a. Circumscribed mass due to fibroadenoma and pleomorphic calcifications due to ductal carcinoma in situ in a 71-year-old woman. (a) Craniocaudal mammogram shows multiple circumscribed masses, one of which has popcorn calcification (arrow) typical of fibroadenoma. The circumscribed mass (*) was consistently described as circumscribed and benign or as probably benign. (b) Four-fold photographic magnification of mass (*) and adjacent calcifications (arrow). A majority of participants and all experienced breast imagers recognized the mass as circumscribed or partially obscured and as benign or probably benign (55% before and 74% after training). The calcifications and mass were considered separately. The calcifications were variably described as punctate and probably benign or as pleomorphic and suggestive of malignancy, even with training.
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Figure 3b. Circumscribed mass due to fibroadenoma and pleomorphic calcifications due to ductal carcinoma in situ in a 71-year-old woman. (a) Craniocaudal mammogram shows multiple circumscribed masses, one of which has popcorn calcification (arrow) typical of fibroadenoma. The circumscribed mass (*) was consistently described as circumscribed and benign or as probably benign. (b) Four-fold photographic magnification of mass (*) and adjacent calcifications (arrow). A majority of participants and all experienced breast imagers recognized the mass as circumscribed or partially obscured and as benign or probably benign (55% before and 74% after training). The calcifications and mass were considered separately. The calcifications were variably described as punctate and probably benign or as pleomorphic and suggestive of malignancy, even with training.
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Figure 4a. Obscured mass due to infiltrating ductal carcinoma and branching and/or fine linear calcifications due to infiltrating ductal carcinoma and ductal carcinoma in situ in a 71-year-old woman. (a) Craniocaudal routine mammogram shows partially obscured mass (arrow) and several groupings of calcifications (arrowheads). (b) Mediolateral oblique spot-compression mammographic view of the mass (arrow) again shows partially obscured or indistinct margins. Since the participants were told to assume that all masses were solid, biopsy was the appropriate recommendation, made prospectively by two of the three experienced imagers. Initially, 68% of participants considered this benign or probably benign. With training, 64% recommended biopsy. (c) Craniocaudal spot-magnification mammogram of the outer right breast better demonstrates the cluster of branching and/or fine linear calcifications (arrow) suggestive of malignancy. The mass and calcifications were considered separate lesions, although participants were aware that the lesions were in the same breast. All participants initially recognized the morphology as either pleomorphic or branching and/or fine linear. In spite of this, 17% of participants initially classified the calcifications as benign or probably benign. After training, all participants recommended biopsy. The more posterior group of hazy calcifications (unlabeled) to the left of those marked with an arrow was due to ductal carcinoma in situ and was not part of the quiz.
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Figure 4b. Obscured mass due to infiltrating ductal carcinoma and branching and/or fine linear calcifications due to infiltrating ductal carcinoma and ductal carcinoma in situ in a 71-year-old woman. (a) Craniocaudal routine mammogram shows partially obscured mass (arrow) and several groupings of calcifications (arrowheads). (b) Mediolateral oblique spot-compression mammographic view of the mass (arrow) again shows partially obscured or indistinct margins. Since the participants were told to assume that all masses were solid, biopsy was the appropriate recommendation, made prospectively by two of the three experienced imagers. Initially, 68% of participants considered this benign or probably benign. With training, 64% recommended biopsy. (c) Craniocaudal spot-magnification mammogram of the outer right breast better demonstrates the cluster of branching and/or fine linear calcifications (arrow) suggestive of malignancy. The mass and calcifications were considered separate lesions, although participants were aware that the lesions were in the same breast. All participants initially recognized the morphology as either pleomorphic or branching and/or fine linear. In spite of this, 17% of participants initially classified the calcifications as benign or probably benign. After training, all participants recommended biopsy. The more posterior group of hazy calcifications (unlabeled) to the left of those marked with an arrow was due to ductal carcinoma in situ and was not part of the quiz.
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Figure 4c. Obscured mass due to infiltrating ductal carcinoma and branching and/or fine linear calcifications due to infiltrating ductal carcinoma and ductal carcinoma in situ in a 71-year-old woman. (a) Craniocaudal routine mammogram shows partially obscured mass (arrow) and several groupings of calcifications (arrowheads). (b) Mediolateral oblique spot-compression mammographic view of the mass (arrow) again shows partially obscured or indistinct margins. Since the participants were told to assume that all masses were solid, biopsy was the appropriate recommendation, made prospectively by two of the three experienced imagers. Initially, 68% of participants considered this benign or probably benign. With training, 64% recommended biopsy. (c) Craniocaudal spot-magnification mammogram of the outer right breast better demonstrates the cluster of branching and/or fine linear calcifications (arrow) suggestive of malignancy. The mass and calcifications were considered separate lesions, although participants were aware that the lesions were in the same breast. All participants initially recognized the morphology as either pleomorphic or branching and/or fine linear. In spite of this, 17% of participants initially classified the calcifications as benign or probably benign. After training, all participants recommended biopsy. The more posterior group of hazy calcifications (unlabeled) to the left of those marked with an arrow was due to ductal carcinoma in situ and was not part of the quiz.
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Copyright © 2002 by the Radiological Society of North America.
