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

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.

journal_name

Acad Radiol

journal_title

Academic radiology

authors

Ambinder EB,Mullen LA,Falomo E,Myers K,Hung J,Lee B,Harvey SC

doi

10.1016/j.acra.2018.09.002

subject

Has Abstract

pub_date

2019-07-01 00:00:00

pages

915-922

issue

7

eissn

1076-6332

issn

1878-4046

pii

S1076-6332(18)30417-3

journal_volume

26

pub_type

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