Breast imaging reporting and data system standardized mammography lexicon: observer variability in lesion description

Area of Science:

• Radiology
• Medical Imaging
• Oncology

Background:

• The American College of Radiology developed the Breast Imaging Reporting and Data System (BI-RADS) to standardize mammographic lesion descriptions.
• Accurate and consistent lesion description is crucial for effective breast cancer diagnosis and management.

Purpose of the Study:

• To evaluate the inter- and intraobserver variability among radiologists when using the BI-RADS standardized lexicon for describing mammographic lesions.
• To assess the consistency of applying BI-RADS terminology across different morphologic categories.

Main Methods:

• Five radiologists independently reviewed 60 mammographic studies with abnormal findings.
• Each lesion was described using BI-RADS lexicon terms for eight morphologic categories.
• Inter- and intraobserver agreement were quantified using Cohen's kappa statistic.

Main Results:

• Substantial agreement was found for describing masses and calcifications (kappa range, 0.50-0.77).
• Considerable variability was observed in the "associated findings" and "special cases" categories (kappa range, -0.02-0.38).
• Moderate interobserver and low intraobserver variability were noted for lesion significance assessment.

Conclusions:

• The BI-RADS lexicon offers a moderately successful standardized language for describing mammographic lesion morphology.
• Reevaluation of specific terms, particularly for calcification descriptors, may enhance the lexicon's consistency and diagnostic utility.