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European Radiology
Published in: European Radiology 8/2012

Open Access 01-08-2012 | Breast

The Breast Imaging Reporting and Data System (BI-RADS) in the Dutch breast cancer screening programme: its role as an assessment and stratification tool

Authors: J. M. H. Timmers, H. J. van Doorne-Nagtegaal, H. M. Zonderland, H. van Tinteren, O. Visser, A. L. M. Verbeek, G. J. den Heeten, M. J. M. Broeders

Published in: European Radiology | Issue 8/2012

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Abstract

Objectives

To assess the suitability of the Breast Imaging Reporting and Data System (BI-RADS) as a quality assessment tool in the Dutch breast cancer screening programme.

Methods

The data of 93,793 screened women in the Amsterdam screening region (November 2005–July 2006) were reviewed. BI-RADS categories, work-up, age, final diagnosis and final TNM classification were available from the screening registry. Interval cancers were obtained through linkage with the cancer registry. BI-RADS was introduced as a pilot in the Amsterdam region before the nationwide introduction of digital mammography (2009–2010).

Results

A total of 1,559 women were referred to hospital (referral rate 1.7 %). Breast cancer was diagnosed in 485 women (detection rate 0.52 %); 253 interval cancers were reported, yielding a programme sensitivity of 66 % and specificity of 99 %. BI-RADS 0 had a lower positive predictive value (PPV, 14.1 %) than BI-RADS 4 (39.1 %) and BI-RADS 5 (92.9 %; P < 0.0001). The number of invasive procedures and tumour size also differed significantly between BI-RADS categories (P < 0.0001).

Conclusion

The significant differences in PPV, invasive procedures and tumour size match with stratification into BI-RADS categories. It revealed inter-observer variability between screening radiologists and can thus be used as a quality assessment tool in screening and as a stratification tool in diagnostic work-up.

Key Points

• The BI-RADS atlas is widely used in breast cancer screening programmes.
• There were significant differences in results amongst different BI-RADS categories.
• Those differences represented the radiologists’ degree of suspicion for malignancy, thus enabling stratification of referrals.
• BI-RADS can be used as a quality assessment tool in screening.
• Training should create more uniformity in applying the BI-RADS lexicon.
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Metadata
Title
The Breast Imaging Reporting and Data System (BI-RADS) in the Dutch breast cancer screening programme: its role as an assessment and stratification tool
Authors
J. M. H. Timmers
H. J. van Doorne-Nagtegaal
H. M. Zonderland
H. van Tinteren
O. Visser
A. L. M. Verbeek
G. J. den Heeten
M. J. M. Broeders
Publication date
01-08-2012
Publisher
Springer-Verlag
Published in
European Radiology / Issue 8/2012
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-012-2409-2

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