title: Using the BI-RADS lexicon in a restrictive form of double reading as a strategy for minimizing screening mammography recall rates.
abstract: OBJECTIVE
  The purpose of this article is to determine the potential reduction in screening recall rates by strictly following standardized BI-RADS lexicon for lesions seen on screening mammography.
  
  
  METHODS
  Of 3084 consecutive mammograms performed at our screening facilities, 345 women with 437 lesions were recalled for additional imaging and constituted our study population. Three radiologists retrospectively classified lesions using the standard BI-RADS lexicon and assigned each to one of four groups: group A, the finding met criteria for recall by the BI-RADS lexicon; group B, the finding did not meet strict BI-RADS criteria for recall but was sufficiently indeterminate to warrant recall by the majority of the study panel; group C, the finding was classifiable by the BI-RADS lexicon but was not recalled because it was benign or stable; and group D, the questioned finding was not considered an abnormality by our study panel. Recall rates and the cancer detection rate were determined. The adjusted recall rate was calculated for lesions considered appropriate for recall (group A), and the reduction in the recall rate was determined.
  
  
  RESULTS
  Nineteen malignancies were detected in our recalled population, for a cancer detection rate of 0.65%. All 19 malignancies were lesions considered appropriate for recall (group A). If only group A lesions had been recalled, the recall rate would have decreased from 11.4% to 6.2%, representing a 46% reduction in recalls without affecting the cancer detection rate.
  
  
  CONCLUSIONS
  Using the BI-RADS lexicon as a decision-making aid may help adjust thresholds for recalling indeterminate or suspicious lesions and reduce recall rates from screening mammography.
authors.affiliation: Department of Radiology, Duke University Medical Center, Duke South Hospital, Durham, NC 27710, USA. ghate001@mc.duke.edu
authors.forename: Sujata V
authors.initials: SV
authors.lastname: Ghate
authors.forename: Jay A
authors.initials: JA
authors.lastname: Baker
authors.forename: Connie E
authors.initials: CE
authors.lastname: Kim
authors.forename: Karen S
authors.initials: KS
authors.lastname: Johnson
authors.forename: Ruth
authors.initials: R
authors.lastname: Walsh
authors.forename: Mary Scott C
authors.initials: MS
authors.lastname: Soo
mesh_terms: D000328:Adult; D000368:Aged; D001071:Appointments and Schedules; D001706:Biopsy / Q000706:statistics & numerical data; D001941:Breast Diseases / Q000000981:diagnostic imaging*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D012189:Retrospective Studies; D009626:Terminology as Topic