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Acad Radiol. 2019 Jul;26(7):915-922. doi: 10.1016/j.acra.2018.09.002. Epub 2018 Sep 27.

Variability in Individual Radiologist BI-RADS 3 Usage at a Large Academic Center: What's the Cause and What Should We Do About It?

Author information

1
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 601 N. Caroline St. Baltimore, MD 21287. Electronic address: emcinto8@jhmi.edu.
2
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 601 N. Caroline St. Baltimore, MD 21287. Electronic address: lmullen1@jhmi.edu.
3
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 601 N. Caroline St. Baltimore, MD 21287. Electronic address: eobadin1@jhmi.edu.
4
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 601 N. Caroline St. Baltimore, MD 21287. Electronic address: kmyers25@jhmi.edu.
5
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 601 N. Caroline St. Baltimore, MD 21287. Electronic address: jhung9@jhmi.edu.
6
Walter Reed National Military Medical Center, Bethesda, Maryland. Electronic address: blee111@jhmi.edu.
7
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 601 N. Caroline St. Baltimore, MD 21287. Electronic address: sharvey7@jhmi.edu.

Abstract

RATIONALE AND OBJECTIVES:

Although the breast imaging reporting and data system (BI-RADS) lists specific criteria for designating a lesion as BI-RADS category 3 (probably benign), there are no target benchmarks for BI-RADS 3 usage rates. This study investigates the variability of BI-RADS 3 rates among a group of academic breast imagers, with the goal of defining more precise utilization.

MATERIALS AND METHODS:

We retrospectively reviewed all diagnostic mammograms performed between July 1, 2013 and August 8, 2017 at our academic institution. The percentage of diagnostic mammograms given a BI-RADS 3 assessment was compared between radiologists using the Chi-square test. We then evaluated for correlation between BI-RADS 3 rate and individual clinical metrics (eg, radiologist experience, cancer detection rate [CDR] and recall rate) using univariate linear regression.

RESULTS:

The study included 13 breast imagers and 24,051 diagnostic breast examinations. There was significant variability in BI-RADS 3 rates between radiologists, ranging from 8.0% to 19.3% (p < 0.001). Increased BI-RADS 3 rates negatively correlated with BI-RADS 1 or 2 rate (p < 0.001) and positively correlated with recall rate (p = 0.03). There was no association between BI-RADS 3 rate and the radiologist's level of experience, BI-RADS 4 or 5 rate, or CDR.

CONCLUSION:

We found significant variability in BI-RADS 3 usage, which seems to be used in place of BI-RADS 1 or 2 findings rather than to avoid biopsy recommendation. BI-RADS 3 rates also directly correlated with recall rate, suggesting a greater degree of uncertainty among specific radiologists. Importantly, increased usage of BI-RADS 3 did not correlate with provider experience or improved CDR.

KEYWORDS:

BI-RADS 3; Breast imaging; breast cancer; short interval follow up

PMID:
30268720
DOI:
10.1016/j.acra.2018.09.002

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