Clarity and brevity prove essential for meaningful breast imaging reports

ECR attendees tested their skills at diagnosing breast disease and learned how to create clear, concise breast imaging reports at Tuesday morning's BI-RADS training in breast imaging session.

Mammography reports throughout much of Europe have too much variety in the choice of words used, which can lead to confusion and even medical mistakes, according to Dr. Ingrid Schreer, a professor of medicine at the University of Kiel in Germany. Young radiologists need to develop the ability to provide clear, concise reports.

The BI-RADS (Breast Imaging Reporting and Data System) approach developed by the American College of Radiology is steadily gaining acceptance in Europe, Schreer said.

BI-RADS classifies images on a scale of 0 to 6:

• 1: absolutely normal

• 2: clearly benign

• 3: probably benign, risk of malignancy less than 2%

• 4: questionable lesion needing immediate histological examination

• 5: highly suspicious, with a high risk of malignancy

• 6: malignancy confirmed with percutaneous biopsy

The zero category is used only for screening mammograms when the findings are inconclusive and another imaging modality is recommended. In reports classified as zero, the radiologist should recommend which adjunct imaging study should be used.

The BI-RADS lexicon is succinct, with a strictly limited choice of words used to describe findings in mammography, ultrasound, and MRI.

Attendees were presented with 10 cases (none with palpable lesions) and asked to evaluate and classify each case using remote control panels on their seats. To give the challenge a real world feel, they had less than a minute to reach their decision for each case. Discussions followed each case.

Not everyone is willing and eager to switch to BI-RADS. The U.K. has its own reporting system, as do many institutions in Scandinavian countries. Without a strict lexicon, radiologists may use a rich, but not always clear, choice of terms in their reports.

BI-RADS uses 22 terms to characterize calcifications, whereas radiologists not adhering to the system may use at least 50 different terms. Some of the descriptive terms used frequently in the U.K. system do not appear in BI-RADS, and not all of these non-BI-RADS descriptors have diagnostic value.

Although radiologists may have valid reasons for not wanting to embrace BI-RADS, proponents such as Schreer say that radiologists need to rely on a reporting lexicon that can be easily understood across Europe. Putting an emphasis on the needs of clear communication in breast imaging diagnosis and reports can help to avoid unnecessary surgery, she said.