Does Training in the Breast Imaging Reporting and Data System (BI-RADS) Improve Biopsy Recommendations or Feature Analysis Agreement with Experienced Breast Imagers at Mammography?

PURPOSE: To determine whether training in the Breast Imaging Reporting and Data System (BI-RADS) improves observer performance and agreement with the consensus of experienced breast imagers with regard to mammographic feature analysis and final assessment. MATERIALS AND METHODS: A test set of mammograms was developed, with 54 proven lesions consisting of 28 masses (nine 32% malignancies) and 26 microcalcifications (10 38% malignancies). Three experienced breast imagers reviewed cases independently and by means of consensus. Twenty-three practicing mammogram-interpreting physicians reviewed mammograms before and after a day's lectures on BI-RADS. Observer performance before and after training was measured by means of agreement (kappa) with consensus description and assessments, rate of biopsy of malignant and benign lesions, and areas under receiver operating characteristic (ROC) curves. Performance was also measured for 11 participants 2-3 months after training. RESULTS: Improved agreement with consensus feature analysis was found for mass margins and/or asymmetries, with a pretraining generalized kappa value of 0.36 and a posttraining generalized kappa value of 0.41. Similar improvement was seen for description of calcification morphology (pretraining kappa value of 0.36 improving to 0.44 after training). No improvement was seen in describing calcification distribution. Final assessments were more consistent after training, with a pretraining kappa value of 0.31, as compared with 0.45 after training. The mean biopsy rate for malignant lesions improved from 73% (range, 53%-89%) before training to 88% (range, 74%-100%) after training, with minimal increase in mean biopsy rate of benign lesions (43% range, 26%-60% before to 51% range, 31%-63% after training), and no net change in area under the ROC curve, as compared with histopathologic findings. For the subset of participants with delayed follow-up, no significant decline in posttraining results was seen. CONCLUSION: BI-RADS training resulted in improved agreement with the consensus of experienced breast imagers for feature analysis and final assessment. It is important that trainees showed improved rates of recommending biopsy for malignant lesions. This effect was maintained over 2-3 months.