Use of the American College of Radiology BI-RADS guidelines by community radiologists: Concordance of assessments and recommendations assigned to screening mammograms

OBJECTIVE. This study evaluated the use of the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) by community radiologists by determining the concordance of assessment categories and recommendations assigned to screening mammograms. MATERIALS AND METHODS. The study comprised the interpretations of 82,620 consecutive screening mammograms by 18 radiologists between January 1, 1995, and December 31, 1998. For all mammograms, assessment categories and recommendations were compared to determine whether they were in accordance with BI-RADS guidelines. Overall patterns of discordance were analyzed, and comparisons of discordant patterns by assessment category, patient age, breast density, and year of examination were made. RESULTS. The overall discordance between BI-RADS assessments and recommendations was low (3%). The assessment with the highest discordance was "probably benign finding" (category 3), at 53.5%. Mammograms obtained in 1998 were almost half as likely to have assessment-recommendation discordance compared with those obtained in 1995 (2.4% vs 4.5%, respectively; odds ratio = 0.52; p < 0.001). Mammograms of women with dense breast tissue were 30% more likely to have lesions assigned discordant assessments and recommendations compared with those of women with fatty tissue (3.4% vs 2.7%, respectively; odds ratio = 1.3; p < 0.001). No differences in the patterns of discordance were found between mammograms of women younger than 50 years and those of women 50 years old and older (p = 0.10). CONCLUSION. There has been improvement in the accurate application of BI-RADS since its introduction. However, variation in the pairing of BI-RADS assessments and recommendations persists. Continued efforts to educate radiologists about the use of BI-RADS and to clarify BI-RADS terms would promote maximum consistency in this use of this reporting method.