ACR BI-RADS Assessment Category 4 Subdivisions in Diagnostic Mammography: Utilization and Outcomes in the National Mammography Database

Purpose To determine the utilization and positive predictive value (PPV) of the American College of Radiology (ACR) Breast Imaging Data and Reporting System (BI-RADS) category 4 subdivisions in diagnostic mammography in the National Mammography Database (NMD). Materials and Methods This study involv...

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Bibliographic Details
Published in:Radiology Vol. 287; no. 2; p. 416
Main Authors: Elezaby, Mai, Li, Geng, Bhargavan-Chatfield, Mythreyi, Burnside, Elizabeth S, DeMartini, Wendy B
Format: Journal Article
Language:English
Published: United States 01.05.2018
Subjects:
Adult
Aged
Aged, 80 and over
Breast Neoplasms - diagnostic imaging
Databases, Factual
Early Detection of Cancer - instrumentation
Female
Humans
Mammography - statistics & numerical data
Middle Aged
Observer Variation
Outcome Assessment (Health Care)
Population Surveillance
Predictive Value of Tests
Radiographic Image Enhancement - methods
Reproducibility of Results
Retrospective Studies
United States
ISSN:1527-1315, 1527-1315
Online Access:Get more information
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Summary:Purpose To determine the utilization and positive predictive value (PPV) of the American College of Radiology (ACR) Breast Imaging Data and Reporting System (BI-RADS) category 4 subdivisions in diagnostic mammography in the National Mammography Database (NMD). Materials and Methods This study involved retrospective review of diagnostic mammography data submitted to the NMD from January 1, 2008 to December 30, 2014. Utilization rates of BI-RADS category 4 subdivisions were compared by year, facility (type, location, census region), and examination (indication, finding type) characteristics. PPV3 (positive predictive value for biopsies performed) was calculated overall and according to category 4 subdivision. The χ test was used to test for significant associations. Results Of 1 309 950 diagnostic mammograms, 125 447 (9.6%) were category 4, of which 33.3% (41 841 of 125 447) were subdivided. Subdivision utilization rates were higher (P < .001) in practices that were community, suburban, or in the West; for examination indication of prior history of breast cancer; and for the imaging finding of architectural distortion. Of 41 841 category 4 subdivided examinations, 4A constituted 55.6% (23 258 of 41 841) of the examinations; 4B, 31.8% (13 302 of 41 841) of the examinations; and 4C, 12.6% (5281 of 41 841) of the examinations. Pathologic outcomes were available in 91 563 examinations, and overall category 4 PPV3 was 21.1% (19 285 of 91 563). There was a statistically significant difference in PPV3 according to category 4 subdivision (P < .001): The PPV of 4A was 7.6% (1274 of 16 784), that of 4B was 22% (2317 of 10 408), and that of 4C was 69.3% (2839 of 4099). Conclusion Although BI-RADS suggests their use, subdivisions were utilized in the minority (33.3% [41 841 of 125 447]) of category 4 diagnostic mammograms, with variability based on facility and examination characteristics. When subdivisions were used, PPV3s were in BI-RADS-specified malignancy ranges. This analysis supports the use of subdivisions in broad practice and, given benefits for patient care, should motivate increased utilization. RSNA, 2018 Online supplemental material is available for this article.
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ISSN:1527-1315
1527-1315
DOI:10.1148/radiol.2017170770