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Published on: August 30, 2013
Utilization and Cancer Yield of Probably Benign Assessment Category in the National Mammography Database: 2009 to
Mai A Elezaby1, Lu Mao2, Elizabeth S Burnside3
1Associate Section Chief, Breast Imaging and Intervention Section, Associate Program Director, Breast Imaging Fellowship, and Associate Program Director, Diagnostic Radiology Residency, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Purpose:
Data on utilization rate and cancer yield of BI-RADS® category 3 in routine clinical practice in diagnostic mammography are sparse. The aim of this study was to determine utilization rate and cancer yield of BI-RADS 3 in diagnostic mammography in the ACR National Mammography Database (NMD).
Methods:
Retrospective analysis of NMD mammograms from January 1, 2009, to June 30, 2018, was performed. BI-RADS 3 utilization rate in diagnostic setting was calculated and stratified by patient, facility, and examination-level variables. Patient-level cancer yield was calculated among women with BI-RADS 3 assessment and adequate follow-up (imaging follow-up ≥24 months or biopsy). Logistic regression was performed to assess the odds of utilization of BI-RADS 3, with respect to facility, examination, and patient variables, and the odds of malignancy among patients with probably benign findings. Chi-square and t tests were used to determine significance (P < .05).
Results:
Data from 19,443,866 mammograms from 500 NMD facilities across 31 states were analyzed, of which 3,039,952 were diagnostic mammograms. Utilization rate of BI-RADS 3 was 15.5% (470,155 of 3,039,952) in the diagnostic setting. There was a statistically significant difference in BI-RADS 3 utilization rate across all collected variables (P < .001). Patient-level cancer yield at 2-year follow-up was 0.91% (2,009 of 220,672; 95% confidence interval [CI], 0.87%-0.95%) in the diagnostic setting. Patient and examination variables associated with significantly higher likelihood of malignancy included calcifications (odds ratio, 4.27; 95% CI, 2.43-7.51), patient age > 70 years (odds ratio, 3.77; 95% CI, 2.49-5.7), and presence of prior comparisons (odds ratio, 1.23; 95% CI, 1.07-1.42).
Conclusions:
In the NMD, BI-RADS 3 assessment was common in diagnostic mammography (15.5%), with an overall cancer yield of 0.91%, less than the benchmark of 2%. Utilization trends in diagnostic mammography warrant further research for optimization of use.
