title: Concordance of BI-RADS Assessments and Management Recommendations for Breast MRI in Community Practice.
abstract: OBJECTIVE
  The purpose of this study was to evaluate concordance between BI-RADS assessments and management recommendations for breast MRI in community practice.
  
  
  METHODS
  Breast MRI data were collected from four regional Breast Cancer Surveillance Consortium registries from 2005 to 2011 for women who were 18-79 years old. Assessments and recommendations were compared to determine concordance according to BI-RADS guidelines. Concordance was compared by assessment category as well as by year of examination and clinical indication.
  
  
  RESULTS
  In all, 8283 MRI examinations were included in the analysis. Concordance was highest (93% [2475/2657]) in examinations with a BI-RADS category 2 (benign) assessment. Concordance was also high in examinations with category 1 (negative) (87% [1669/1909]), category 0 (incomplete) (83% [348/417]), category 5 (highly suggestive of malignancy) (83% [208/252]), and category 4 (suspicious) (74% [734/993]) assessments. Examinations with categories 3 (probably benign) and 6 (known biopsy-proven malignancy) assessments had the lowest concordance rates (36% [302/837] and 56% [676/1218], respectively). The most frequent discordant recommendation for a category 3 assessment was routine follow-up. The most frequent discordant recommendation for a category 6 assessment was biopsy. Concordance of assessments and management recommendations differed across clinical indications (p < 0.0001), with the lowest concordance in examinations to assess disease extent.
  
  
  CONCLUSIONS
  Breast MRI BI-RADS management recommendations were most concordant for assessments of negative, incomplete, suspicious, and highly suggestive of malignancy. Lower concordance for assessments of probably benign and known biopsy-proven malignancy and for examinations performed to assess disease extent highlight areas for interventions to improve breast MRI reporting.
authors.affiliation: 1 Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA.|2 Present address: Department of Radiology and Biomedical Imaging, University of California San Francisco, 1600 Divisadero St, UCSF Box 1667, San Francisco, CA 94115.
authors.forename: Amie Y
authors.initials: AY
authors.lastname: Lee
authors.affiliation: 3 Group Health Research Institute, Seattle, WA.
authors.forename: Laura
authors.initials: L
authors.lastname: Ichikawa
authors.affiliation: 1 Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA.
authors.forename: Janie M
authors.initials: JM
authors.lastname: Lee
authors.affiliation: 1 Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA.
authors.forename: Christoph I
authors.initials: CI
authors.lastname: Lee
authors.affiliation: 4 Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Wendy B
authors.initials: WB
authors.lastname: DeMartini
authors.affiliation: 2 Present address: Department of Radiology and Biomedical Imaging, University of California San Francisco, 1600 Divisadero St, UCSF Box 1667, San Francisco, CA 94115.
authors.forename: Bonnie N
authors.initials: BN
authors.lastname: Joe
authors.affiliation: 3 Group Health Research Institute, Seattle, WA.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Wernli
authors.affiliation: 5 Department of Surgery, University of Vermont, Burlington, VT.
authors.forename: Brian L
authors.initials: BL
authors.lastname: Sprague
authors.affiliation: 6 Department of Radiology, University of Vermont, Burlington, VT.
authors.forename: Sally D
authors.initials: SD
authors.lastname: Herschorn
authors.affiliation: 1 Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA.
authors.forename: Constance D
authors.initials: CD
authors.lastname: Lehman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008327:Mammography; D008875:Middle Aged; D011159:Population Surveillance; D012042:Registries; D014481:United States / Q000453:epidemiology
keywords: BI-RADS; Breast Cancer Surveillance Consortium; breast MRI; breast cancer; concordance