AJR: Rad community compliance with BI-RADS on the increase

The majority of patients presenting with probably benign findings on their mammography studies are now recommended for short-interval follow-up by way of the American College of Radiology's (ACR) BI-RADS, but the probability of short-interval follow-up recommendations varies by patient and radiologist characteristics, found a study in the April issue of the American Journal of Roentgenology.

Erin J. Aiello Bowles, MPH, of Group Health Research Institute of Seattle, and colleagues explained that historically, radiologists in community practice have not consistently linked a probably benign assessment with a management recommendation of a short-interval follow-up. They sought to evaluate predictors of discordance between probably benign assessments and short-interval follow-up recommendations.

Using data from the Breast Cancer Surveillance Consortium between 2001 and 2006, the study linked data on 196 radiologists who completed a survey on demographic and practice patterns to 15,515 diagnostic mammograms they interpreted with probably benign assessments, or had given a final BI-RADS assessment of category three. Patient characteristics of all 15,515 women were collected at the time of the mammography exam and all short-interval follow-up recommendations were included regardless of the recommended time interval for follow-up, although 84 percent of the 15,515 exams were recommended for follow-up in six months, explained the authors.

The researchers used logistic regression to determine whether patient and radiologist characteristics were associated with the odds of short-interval follow-up recommendations (relative to a recommendation for normal follow-up, additional imaging evaluation, or biopsy or surgical consultation).

Aiello Bowles and colleagues found that 90.9 percent of mammograms with probably benign findings were recommended for short-interval follow-up.  The remaining 4.3 percent were recommended for normal follow-up, 3 percent for additional imaging and 1.8 percent for biopsy or surgical consultation.

In addition, the researchers observed that women with probably benign findings were less likely to receive a short-interval follow-up recommendation if they had extremely dense breasts compared to almost entirely fatty breasts, or those who had presented with a breast lump compared to those with no symptoms.

The authors also noted that radiologist experience was a factor in determining short-interval follow-up. “Radiologists were less likely to recommend short-term follow-up if they had greater than 20 years of experience, compared to those with less than 10 years of experience, but more likely if they practiced primarily at an academic medical center versus other institutions,” they wrote.

Noting the importance of this finding, the researchers said that by understanding the factors that influence a radiologist's management of probably benign lesions, the information may help in designing practice-based interventions to reduce variability in mammographic performance.

“We found that most diagnostic mammograms assessed as probably benign were given a recommendation for short-interval follow-up as suggested by the BI-RADS Atlas and that the percentage of short-interval follow-up recommendations increased over time, reaching 96.7 percent in 2006,” concluded Aiello Bowles and colleagues, who added that the numbers found by this study are substantially higher than other instances of short-interval follow-up recommendations after BI-RADS category three assessments than reported in previous studies.