The breast imaging reporting and data system (bi-rads) in the dutch breast cancer screening programme: Its role as an assessment and stratification tool

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 BIRADS lexicon.