title: The Breast Imaging Reporting and Data System (BI-RADS) in the Dutch breast cancer screening programme: its role as an assessment and stratification tool.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  • 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 BI-RADS lexicon.
authors.affiliation: National Expert and Training Centre for Breast Cancer Screening, PO Box 6873, 6503 GJ Nijmegen, the Netherlands. j.timmers@lrcb.nl
authors.forename: J M H
authors.initials: JM
authors.lastname: Timmers
authors.forename: H J
authors.initials: HJ
authors.lastname: van Doorne-Nagtegaal
authors.forename: H M
authors.initials: HM
authors.lastname: Zonderland
authors.forename: H
authors.initials: H
authors.lastname: van Tinteren
authors.forename: O
authors.initials: O
authors.lastname: Visser
authors.forename: A L M
authors.initials: AL
authors.lastname: Verbeek
authors.forename: G J
authors.initials: GJ
authors.lastname: den Heeten
authors.forename: M J M
authors.initials: MJ
authors.lastname: Broeders
mesh_terms: D000368:Aged; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000175:diagnosis*; D016208:Databases, Factual; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods; D008495:Medical Oncology / Q000379:methods / Q000592:standards; D008875:Middle Aged; D009426:Netherlands; D015588:Observer Variation; D012042:Registries; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity