Top

Open Access 06-11-2024 | Mammography | Breast

Inter-reader agreement of the BI-RADS CEM lexicon

Authors: Calogero Zarcaro, Ambra Santonocito, Layla Zeitouni, Francesca Ferrara, Panagiotis Kapetas, Ruxandra-Iulia Milos, Thomas H. Helbich, Pascal A. T. Baltzer, Paola Clauser

Published in: European Radiology

Abstract

Purpose

The purpose of this study was to assess the inter-reader agreement of the breast imaging reporting and data system (BI-RADS) contrast-enhanced mammography (CEM) lexicon.

Materials and methods

In this IRB-approved, single-center, retrospective study, three breast radiologists, each with different levels of experience, reviewed 462 lesions in 421 routine clinical CEM according to the fifth edition of the BI-RADS lexicon for mammography and to the first version of the BI-RADS lexicon for CEM. Readers were blinded to patient outcomes and evaluated breast and lesion features on low-energy (LE) images (breast density, type of lesion, associated architectural distortion), lesion features on recombined (RC) images (type of enhancement, characteristic of mass enhancement, non-mass enhancement or enhancing asymmetry), and provided a final BI-RADS assessment. The inter-reader agreement was calculated for each evaluated feature using Fleiss’ kappa coefficient. Sensitivity and specificity were calculated.

Results

The inter-reader agreement was moderate to substantial for breast density (ĸ = 0.569), type of lesion on LE images (ĸ = 0.654), and type of enhancement (ĸ = 0.664). There was a moderate to substantial agreement on CEM mass enhancement descriptors. The agreement was fair to moderate for non-mass enhancement and enhancing asymmetry descriptors. Inter-reader agreement for LE and LE with RC BI-RADS assessment was moderate (ĸ = 0.421) and fair (ĸ = 0.364). Diagnostic performance was good and comparable for all readers.

Conclusion

Inter-reader agreement of the CEM lexicon was moderate to substantial for most features. There was a low agreement for some RC descriptors, such as non-mass enhancement and enhancing asymmetry, and BI-RADS assessment, but this did not impact the diagnostic performance.

Key Points

Question Data on the reproducibility and inter-reader agreement for the first version of the BI-RADS lexicon dedicated to CEM are missing.

Finding The inter-reader agreement for the lexicon was overall substantial to moderate, but it was lower for the descriptors for non-mass enhancement and enhancing asymmetry.

Clinical relevance A common lexicon simplifies communication between specialists in clinical practice. The good inter-reader agreement confirms the effectiveness of the CEM-BIRADS in ensuring consistent communication. Detailed definitions of some descriptors (non-mass, enhancing asymmetry) are needed to ensure higher agreements.

D’Orsi C, Sickles EA, Mendelson EB et al (2013) ACR BI-RADS® Atlas, breast imaging reporting and data system. American College of Radiology, Reston

Jochelson MS, Lobbes MBI (2021) Contrast-enhanced mammography: state of the art. Radiology 299:36–48. https://doi.org/10.1148/radiol.2021201948CrossRefPubMed

Patel BK, Lobbes MBI, Lewin J (2018) Contrast enhanced spectral mammography: a review. Semin Ultrasound CT MR 39:70–79. https://doi.org/10.1053/j.sult.2017.08.005CrossRefPubMed

Dromain C, Thibault F, Diekmann F et al (2012) Dual-energy contrast-enhanced digital mammography: initial clinical results of a multireader, multicase study. Breast Cancer Res 14:R94. https://doi.org/10.1186/bcr3210CrossRefPubMedPubMedCentral

Lalji UC, Houben IPL, Prevos R et al (2016) Contrast-enhanced spectral mammography in recalls from the Dutch breast cancer screening program: validation of results in a large multireader, multicase study. Eur Radiol 26:4371–4379. https://doi.org/10.1007/s00330-016-4336-0CrossRefPubMedPubMedCentral

Berg WA, Berg JM, Bandos AI et al (2024) Addition of contrast-enhanced mammography to tomosynthesis for breast cancer detection in women with a personal history of breast cancer: prospective TOCEM trial interim analysis. Radiology 311:e231991. https://doi.org/10.1148/radiol.231991CrossRefPubMed

Pötsch N, Vatteroni G, Clauser P et al (2022) Contrast-enhanced mammography versus contrast-enhanced breast MRI: a systematic review and meta-analysis. Radiology 305:94–103. https://doi.org/10.1148/radiol.212530CrossRefPubMed

Sumkin JH, Berg WA, Carter GJ et al (2019) Diagnostic performance of MRI, molecular breast imaging, and contrast-enhanced mammography in women with newly diagnosed breast cancer. Radiology 293:531–540. https://doi.org/10.1148/radiol.2019190887CrossRefPubMed

Lee CH, Phillips J, Sung JS et al (2022) CONTRAST ENHANCED MAMMOGRAPHY (CEM) (A supplement to ACR BI-RADS® Mammography 2013). American College of Radiology, Reston

10.

Sickles EA, D’Orsi CJ, Bassett L et al (2022) ACR BI-RADS® mammography. In: ACR BI-RADS® Atlas, breast imaging reporting and data system, 5th edn. American College of Radiology, Reston

11.

Fleiss JL (1971) Measuring nominal scale agreement among many raters. Psychol Bull 76:378–382. https://doi.org/10.1037/h0031619CrossRef

12.

Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174CrossRefPubMed

13.

Grimm LJ, Anderson AL, Baker JA et al (2015) Interobserver variability between breast imagers using the fifth edition of the BI-RADS MRI lexicon. AJR Am J Roentgenol 204:1120–1124. https://doi.org/10.2214/AJR.14.13047CrossRefPubMed

14.

Jansen SA, Shimauchi A, Zak L et al (2011) The diverse pathology and kinetics of mass, nonmass, and focus enhancement on MR imaging of the breast. J Magn Reson Imaging 33:1382–1389. https://doi.org/10.1002/jmri.22567CrossRefPubMedPubMedCentral

15.

Chikarmane SA, Michaels AY, Giess CS (2017) Revisiting nonmass enhancement in breast MRI: analysis of outcomes and follow-up using the updated BI-RADS atlas. AJR Am J Roentgenol 209:1178–1184. https://doi.org/10.2214/AJR.17.18086CrossRefPubMed

16.

Knogler T, Homolka P, Hoernig M et al (2017) Application of BI-RADS descriptors in contrast-enhanced dual-energy mammography: comparison with MRI. Breast Care 12:212–216. https://doi.org/10.1159/000478899CrossRefPubMedPubMedCentral

17.

Nicosia L, Bozzini AC, Palma S et al (2022) A score to predict the malignancy of a breast lesion based on different contrast enhancement patterns in contrast-enhanced spectral mammography. Cancers (Basel) 14:4337. https://doi.org/10.3390/cancers14174337CrossRefPubMed

18.

Berg WA, Campassi C, Langenberg P, Sexton MJ (2000) Breast imaging reporting and data system: inter- and intraobserver variability in feature analysis and final assessment. AJR Am J Roentgenol 174:1769–1777. https://doi.org/10.2214/ajr.174.6.1741769CrossRefPubMed

19.

Ciatto S, Houssami N, Apruzzese A et al (2005) Categorizing breast mammographic density: intra- and interobserver reproducibility of BI-RADS density categories. Breast 14:269–275. https://doi.org/10.1016/j.breast.2004.12.004CrossRefPubMed

20.

Alikhassi A, Esmaili Gourabi H, Baikpour M (2018) Comparison of inter- and intra-observer variability of breast density assessments using the fourth and fifth editions of breast imaging reporting and data system. Eur J Radiol Open 5:67–72. https://doi.org/10.1016/j.ejro.2018.04.002CrossRefPubMedPubMedCentral

21.

Lee AY, Wisner DJ, Aminololama-Shakeri S et al (2017) Inter-reader variability in the use of BI-RADS descriptors for suspicious findings on diagnostic mammography: a multi-institution study of 10 academic radiologists. Acad Radiol 24:60–66. https://doi.org/10.1016/j.acra.2016.09.010CrossRefPubMed

22.

Redondo A, Comas M, Macià F et al (2012) Inter- and intraradiologist variability in the BI-RADS assessment and breast density categories for screening mammograms. Br J Radiol 85:1465–1470. https://doi.org/10.1259/bjr/21256379CrossRefPubMedPubMedCentral

23.

Cozzi A, Magni V, Zanardo M et al (2022) Contrast-enhanced mammography: a systematic review and meta-analysis of diagnostic performance. Radiology 302:568–581. https://doi.org/10.1148/radiol.211412CrossRefPubMed

Title: Inter-reader agreement of the BI-RADS CEM lexicon
Authors: Calogero Zarcaro
Ambra Santonocito
Layla Zeitouni
Francesca Ferrara
Panagiotis Kapetas
Ruxandra-Iulia Milos
Thomas H. Helbich
Pascal A. T. Baltzer
Paola Clauser
Publication date: 06-11-2024
Publisher: Springer Berlin Heidelberg
Keywords: Mammography
Mammography
Published in: European Radiology
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-024-11176-7

Keynote series | Spotlight on menopause

Springer Medicine

Inter-reader agreement of the BI-RADS CEM lexicon

Abstract

Purpose

Materials and methods

Results

Conclusion

Key Points

Keynote series | Spotlight on menopause

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusion

Key Points

Please log in to get access to this content