Abstract
ObjectivesTo 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.MethodsThe 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).ResultsA 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).ConclusionThe 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.
Highlights
The Dutch nationwide breast cancer screening programme was introduced in 1989 and fully implemented in 1997
Between 1 November 2005 and 30 June 2006, 93,793 women participated in the screening programme for breast cancer in the Amsterdam region and 1,559 women were referred to a hospital for diagnostic work-up
Assigning BIRADS 0 varied from 27 % to 72 % and Breast Imaging Reporting and Data System (BI-RADS) 4 from 20 % to 62 %, while BI-RADS 5 showed little difference. In this retrospective study we evaluated the use of the BIRADS final assessment in the Dutch breast cancer screening setting
Summary
The Dutch nationwide breast cancer screening programme was introduced in 1989 and fully implemented in 1997. The target population consisted of women aged. Every 2 years, eligible women are invited for mammographic screening. Since the start of the programme, over 13 million screening examinations have been performed and 56,000 breast cancers have been detected [2]. In The Netherlands, women with a positive screening examination are referred to their general practitioner and subsequently to a hospital of their choice for further assessment [3]. Diagnostic work-up after referral is not an integrated part of the screening programme like in many other countries but is carried out in general or academic hospitals (a reason to avoid the more common international term ‘recall’). Additional imaging (e.g. ultrasound and/or magnification views) is performed in these hospitals and only when necessary, additional imaging is followed by a biopsy
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