Observer agreement using the ACR Breast Imaging Reporting and Data System (BI-RADS)-ultrasound, First Edition (2003).
OBJECTIVE
This study aims to evaluate the degree of inter- and intraobserver agreement when characterizing breast abnormalities using the Breast Imaging Reporting and Data System (BI-RADS)-ultrasound (US) lexicon, as defined by the American College of Radiology (ACR).


METHODS
Two hundred ninety three female patients with 314 lesions underwent US-guided biopsies at one facility during a two-year period. Static sonographic images of each breast lesion were acquired and reviewed by four radiologists with expertise in breast imaging. Each radiologist independently evaluated all cases and described the mass according to BI-RADS-US. To assess intraobserver variability, one of the four radiologists reassessed all of the cases one month after the initial evaluation. Inter- and intraobserver variabilities were determined using Cohen's kappa (k) statistics.


RESULTS
The greatest degree of reliability for a descriptor was found for mass orientation (k = 0.61) and the least concordance of fair was found for the mass margin (k = 0.32) and echo pattern (k = 0.36). Others descriptive terms: shape, lesion boundary and posterior features (k = 0.42, k = 0.55 and k = 0.53, respectively) and the final assessment (k = 0.51) demonstrated only moderate levels of agreement. A substantial degree of intraobserver agreement was found when classifying all morphologic features: shape, orientation, margin, lesion boundary, echo pattern and posterior feature (k = 0.73, k = 0.68, k = 0.64, 0.68, k = 0.65 and k = 0.64, respectively) and rendering final assessments (k = 0.65).


CONCLUSIONS
Although BI-RADS-US was created to achieve a consensus among radiologists when describing breast abnormalities, our study shows substantial intraobserver agreement but only moderate interobserver agreement in the mass description and final assessment of breast abnormalities according to its use. A better agreement will ultimately require specialized education, as well as self-auditing practice tests.
Park
Chang Suk
CS
Department of Radiology, Our Lady of Mercy Hospital, College of Medicine, The Catholic University of Korea, Korea.
Lee
Jae Hee
JH
Yim
Hyeon Woo
HW
Kang
Bong Joo
BJ
Kim
Hyeon Sook
HS
Jung
Jung Im
JI
Jung
Na Young
NY
Kim
Sung Hun
SH
D000230:Adenocarcinoma / Q000145:classification / Q000175:diagnosis*; D002288:Adenocarcinoma, Mucinous / Q000145:classification / Q000175:diagnosis*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001943:Breast Neoplasms / Q000145:classification / Q000175:diagnosis*; D018270:Carcinoma, Ductal, Breast / Q000145:classification / Q000175:diagnosis*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000145:classification / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D011871:Radiology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012955:Societies, Medical; D009626:Terminology as Topic; D018615:Ultrasonography, Doppler, Color / Q000706:statistics & numerical data; D016217:Ultrasonography, Mammary / Q000706:statistics & numerical data*