Reader variability in reporting breast imaging according to BI-RADS® assessment categories (the Florence experience)

Ciatto, Stefano; Houssami, Nehmat; Apruzzese, A.; Bassetti, E.; Brancato, Beniamino; Carozzi, Francesca; Catarzi, S; Lamberini, M.P.; Marcelli, G; Pellizzoni, R.; Pesce, Bárbara; Risso, Gabriella; Russo, Filippo; Scorsolini, A.

doi:10.1016/j.breast.2005.04.019

Cited by 50 publications

(44 citation statements)

References 5 publications

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“…Fair to moderate inter-observer agreement between experienced breast imagers for overall BI-RADS 4th edition's categories in our study was very similar to the studies reported by Lazarus et al [6] and Ciatto et al [11]. However, the kappa values in our study for the BI-RADS 3rd edition were much higher than for the BI-RADS 4th edition, and this fact may be explained by a greater number of categories offered (i.e., inclusion of the 4a, 4b, and 4c subcategories in the 4th edition).…”

Section: Conflict Of Interestsupporting

confidence: 81%

Observer Variability of the Breast Imaging Reporting and Data System (BI-RADS) Lexicon for Mammography

Adıbelli

Ergenc²,

Öztekin³

et al. 2010

Breast Care

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Aim: We aimed to determine the inter- and intra-observer variabilities between breast radiologists and a general radiologist in categorizing mammographic lesions using the Breast Imaging Reporting and Data System (BI-RADS), and to evaluate the effects of the histopathologic results on the variability. Methods: Mammograms from 142 women who underwent biopsy were evaluated. 3 breast radiologists (2 with >10 years experience and 1 with 1 year experience) and 1 general radiologist retrospectively reviewed mammograms twice within an 8-week interval. Inter- and intra-observer variabilities were assessed with Cohen’s kappa statistic, and the positive predictive value for final assessments was calculated. Results: The intra-observer variability for mass and calcification assessments was moderate to almost perfect (kappa values: 0.41–1) for breast imagers and was fair to substantial for the general radiologist (kappa values: 0.21–0.8). Inter-observer agreement between the breast imagers was higher than between the breast and general radiologists. There was no apparent difference in agreement between observers for malignant and benign subgroups. Conclusions: The differences in intra- and inter-observer agreement between the breast imagers and the general radiologist affirm the utility of the BI-RADS lexicon. The histopathologic re-sults of the lesions do not affect the agreement. BI-RADS is a simple and adequate tool for assessing mammograms, even after only 1 year of training.

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Section: Conflict Of Interestsupporting

confidence: 81%

Observer Variability of the Breast Imaging Reporting and Data System (BI-RADS) Lexicon for Mammography

Adıbelli

Ergenc²,

Öztekin³

et al. 2010

Breast Care

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“…18,19 The overall diagnostic agreement was low 19 to moderate 18 but improved in the BI-RADS5 category 18,19 and with experienced readers. 20 Conclusions for the Management of Patients According to the Number of Pejorative Criteria and the Type of Atypia…”

Section: Interobserver Reproducibility In the Classification Of Radiomentioning

confidence: 99%

“…Among B3 lesions, there were 147 atypical ductal hyperplasia and 27 lobular neoplasia including lobular carcinoma in situ with, respectively, 49 and 8 cancers at excision. One reason why previous results must be interpreted with caution, and which potentially explains the discrepancies in results observed, is that interobserver reproducibility in the classification of radiological lesions remains at present low 18 to moderate, 19 especially for non-experienced readers 20 and it is the same for histological lesions 21 since distinguishing between flat epithelial atypia and atypical ductal hyperplasia is sometimes difficult using the WHO criteria. 22 Furthermore, the distinction between atypical ductal hyperplasia and low-grade ductal carcinoma in situ on a core biopsy specimen is uncertain since the extent of atypia cannot be accurately assessed.…”

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confidence: 95%

All atypia diagnosed at stereotactic vacuum-assisted breast biopsy do not need surgical excision

et al. 2011

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The necessity of excision is debatable when atypia are diagnosed at stereotactic vacuum-assisted breast biopsy (microbiopsy). Among the 287 surgical excisions performed at Institut Bergonié from 1999 to 2009, we selected a case-control study group of 151 excisions; 52 involving all the diagnosed cancers and 99 randomly selected among the 235 excisions without cancer, following atypical microbiopsy (24 flat epithelial atypia; 50 atypical ductal hyperplasia; 14 lobular neoplasia; 63 mixed lesions). Mammographical calcification (type, extension, complete removal) and histological criteria of epithelial atypia (type, number of foci, size/extension), topography and microcalcification extension at microbiopsy were compared according to the presence or absence of cancer at excision. Factors associated with cancer at excision were Breast Imaging Reporting and Data System (BI-RADS5) lesions, large and/or multiple foci of mammographical calcifications, histological type, number, size and extension of atypical foci. Flat epithelial atypia alone was never associated with cancer at excision. BI-RADS5, atypical ductal hyperplasia (alone or predominant) and 43 foci of atypia were identified as independent pejorative factors. There was never any cancer at excision when these pejorative factors were absent (n ¼ 31). Presence of one (n ¼ 59), two (n ¼ 23) or three (n ¼ 14) factors was associated with cancer in 24, 15 and 13 cases with an odds ratio ¼ 5.8 (95% CI: 3-11.2) for each additional factor. We recommend that mammographical data and histological characteristics be taken into account in the decision-making process after diagnosis of atypia on microbiopsy. With experienced senologists and strict histological criteria, some patients could be spared surgery resulting in significant patient, financial and time advantages.

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“…Hatta BI-RADS 5 lezyonlarda uyum en yüksek oranda bulunmuştur. Ciatto ve arkadaşlarının [4] 50 vaka ve 12 radyolog arasında yaptıkları bir çalışmada da benzer oranlar saptanmıştır Bizim çalışmamız-da kanserli olguların iki radyolog arasındaki uyumu, kanserli olmayan olgulardan daha iyiydi ancak Kerlikowske ve arkadaşla-rının [10] yaptığı benzer bir çalışmada bu uyum kanserli olmayan normal mamografili olgularda daha belirgin bulunmuştur. Bunun nedeni BI-RADS kategorileme sisteminde malignite yö-nünden şüpheli olgulara ek tetkik gerektiren olgu, yüksek olası-lıkla malign veya biyopsi gerektiren olgular şeklinde değişik yaklaşımlar yapılabilmesi ve bunun da maligniteleri kategorilemede çeşitlilik oluşturduğunu belirtmişler.…”

Section: Discussionunclassified

Is Interpretation Differences of Radiologists an Important Issue in Breast Imaging Reporting and Data System?

Parlak¹

2013

Ann Clin Anal Med

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ÖzetAmaç: Çalışmamızın amacı Meme Görüntüleme Raporlama ve Veri Sisteminin radyologlar arasında kullanımında uyumu araştırmak, oluşan farklılıkların nedenlerini ve bu farklılıkların en çok hangi kategorilerde gerçekleştiğinin belirlemektir. Gereç ve Yöntem: Tarama amaçlı mamografi çekilen 773 hastanın mamografileri 2 radyolog tarafından retrospektif ve birbirlerinden bağım-sız olarak değerlendirildi. Tüm sonuçlar Meme Görüntüleme Raporlama ve Veri Sistemine göre değerlendirildi. Kategori 1, 2 ve 3 benign, kategori 4 ve 5 ise malignite şüpheli lezyonlar ile uyumlu olarak değerlendirildi. Gözlemci-lerin benign ve malign lezyonlar arası uyumu ve tüm kategoriler arası uyumu Kappa testi ile araştırıldı. Bulgular: Çalışmaya alınan 773 hastanın 554'ünde her iki radyolog aynı kategoriyi raporlarken kalan 219 hastada farklı kategoriler raporlanmıştır. Her iki gözlemci arasındaki uyumu araştırmak için kullanılan Kappa testinin değeri istatiksel olarak anlamlı bulundu (p=0,001) ve 0.602 değeri orta derecede uyum olarak değerlendirildi. Meme Görüntüleme Raporlama ve Veri Sistemi skoruna göre benign ve malign riskte değerlendi-rilen hastaların mamografileri arasındaki uyum araştırıldığında benign olgular kategori 1, 2, 3 olarak kabul edilirken, kategori 4 ve 5 ise malignite şüphe-li lezyonlar olarak değerlendirilmiştir. Benign ve malign olgular arasında Kappa testinin değeri istatiksel olarak anlamlı bulundu (p=0,001) ve 0.857 ile mü-kemmel derecede uyum olarak değerlendirildi. Her iki gözlemci arasında kategori 5 lezyonlar arasında mutlak uyum var iken en çok fark kategori 3 lezyonlarda saptandı. Tartışma: Meme Görüntüleme Raporlama ve Veri Sistemi terminolojisi memede saptanan lezyonların sınıflanması, arada oluşan karışıklıkların önlenmesi ve klinisyenlerin lezyonlara yaklaşımları açısından ortak bir dil oluşturmayı amaçlamaktadır. İstenilen düzeyde olmasa da mamografi raporlamasında belli bir standardizasyon sağlanmıştır. Ancak yorumcular arası oluşan uyumsuzluk Meme Görüntüleme Raporlama ve Veri Sisteminin yapılan çalışmalar ve görüşler doğrultusunda belirli aralıklarla güncellen-mesi gerektiğini göstermektedir. Anahtar KelimelerMamografi; Meme; Radyolog Abstract Aim:The aim of our study is to search the reproducibility of the radiologists using Breast Imaging Reporting and Data System, to determine the reasons of differences in interpretation and find out in which categories inerterpretation differences occur mostly. Material and Method: Screening mammograms of 773 patients were evaluated retrospectively and independently by 2 radiologists. All results were evaluated according to the Breast Imaging Reporting and Data System. Category 1, 2, 3 were accepted as benign, category 4 and 5 were considered as "lesions suspicios for malignancy". Consistency of the radiologists in benign and malign lesions and also in all categories, was statistically examined by Kappa test. Results: Of the 773 patients of the study 554 were categorized identically by the 2 radiologists whereas 219 patients were categorized differently. Kappa va...

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Reader variability in reporting breast imaging according to BI-RADS® assessment categories (the Florence experience)

Cited by 50 publications

References 5 publications

Observer Variability of the Breast Imaging Reporting and Data System (BI-RADS) Lexicon for Mammography

Observer Variability of the Breast Imaging Reporting and Data System (BI-RADS) Lexicon for Mammography

All atypia diagnosed at stereotactic vacuum-assisted breast biopsy do not need surgical excision

Is Interpretation Differences of Radiologists an Important Issue in Breast Imaging Reporting and Data System?

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