Interobserver Variability Between Breast Imagers Using the Fifth Edition of the BI-RADS MRI Lexicon

The purpose of this study was to assess the interobserver variability of users of the MRI lexicon in the fifth edition of the BI-RADS atlas.

Three breast imaging specialists reviewed 280 routine clinical breast MRI findings reported as BI-RADS category 3. Lesions reported as BI-RADS 3 were chosen because variability in the use of BI-RADS descriptors may influence which lesions are classified as probably benign. Each blinded reader reviewed every study and recorded breast features (background parenchymal enhancement) and lesion features (lesion morphology, mass shape, mass margin, mass internal enhancement, nonmass enhancement distribution, nonmass enhancement internal enhancement, enhancement kinetics) according to the fifth edition of the BI-RADS lexicon and provided a final BI-RADS assessment. Interobserver variability was calculated for each breast and lesion feature and for the final BI-RADS assessment.

Interobserver variability for background parenchymal enhancement was fair (ĸ = 0.28). There was moderate agreement on lesion morphology (ĸ = 0.53). For masses, there was substantial agreement on shape (ĸ = 0.72), margin (ĸ = 0.78), and internal enhancement (ĸ = 0.69). For nonmass enhancement, there was substantial agreement on distribution (ĸ = 0.69) and internal enhancement (ĸ = 0.62). There was slight agreement on lesion kinetics (ĸ = 0.19) and final BI-RADS assessment (ĸ = 0.11).

There is moderate to substantial agreement on most MRI BI-RADS lesion morphology descriptors, particularly mass and nonmass enhancement features, which are important predictors of malignancy. Considerable disagreement remains, however, among experienced readers whether to follow particular findings.