Recommendation for Short-Interval Follow-Up Examinations After a Probably Benign Assessment: Is Clinical Practice Consistent With BI-RADS Guidance?

Abstract

Objective American College of Radiology BI-RADS guidance suggests that women with a probably benign finding on mammography receive a management recommendation for short-interval follow-up; historically, radiologists in community practice have not consistently linked this assessment with short-interval follow-up. We evaluated predictors of discordance between probably benign assessments and short-interval follow-up recommendations. Materials and Methods We linked data on 196 radiologists who completed a survey on demographic and practice patterns to 15,515 diagnostic mammograms they interpreted with probably benign assessments between 2001 and 2006. Patient characteristics were collected at the time of the mammography. Using logistic regression, we examined whether patient and radiologist characteristics were associated with the odds of short-interval follow-up recommendations (relative to a recommendation for normal follow-up, additional imaging evaluation, or biopsy or surgical consultation). Results Overall, 90.9% of mammograms with probably benign findings were recommended for short-interval follow-up; 4.3% were recommended for normal follow-up, 3.0% for additional imaging, and 1.8% for biopsy or surgical consultation. Women with probably benign findings were less likely to receive a short-interval follow-up recommendation if they had extremely dense breasts versus almost entirely fatty breasts (odds ratio [OR], 0.61; 95% CI, 0.39–0.96) or had a breast lump versus no symptoms (OR, 0.55; 95% CI, 0.38–78). Radiologists were less likely to recommend short-interval follow-up if they had ≥ 20 years of experience versus < 10 years of experience (OR, 0.57; 95% CI, 0.36–0.90) but more likely if they practiced primarily at an academic medical center versus other institutions (OR, 2.66; 95% CI, 1.14–6.21). Conclusion In contrast to older studies, the majority of probably benign assessments are now recommended for short-interval follow-up, but the probability of short-interval follow-up recommendations varies by patient and radiologist characteristics.

Time to definitive diagnosis of breast cancer in Latina and non-Hispanic white women: the six cities study

“…If diagnosis did not occur within the time frame of the study, cases remained undiagnosed and time was calculated as the interval from their date of index abnormal mammogram to the last known visit date or the end of the study, whichever occurred first. For women with BI-RADS-3 mammogram results and time to diagnosis >180 days, time to definitive diagnosis was shifted backward 180 days to account for the ACR-recommended short-interval follow-up (repeat mammogram in six months) (Aiello Bowles 2010; Battaglia et al 2010). These data were derived from patient clinical records, scheduling information, and key informant interviews with healthcare personnel from the clinic.…”

The Utility of Short-Interval Follow-Up for Baseline High-Risk Screening Breast MRI

“…The few published studies evaluating the frequency of BI-RADS 3 categorization in breast MRI screening report a rate of 6% to 12%. [12][13][14] Therefore, further research may be directed toward evaluating the indications for follow-up in baseline screening examinations to achieve the 6% to 12% range. A few studies have been performed evaluating the common indications for short-interval follow-up breast MRI and whether they are appropriate for such a recommendation.…”

“…A few studies have been performed evaluating the common indications for short-interval follow-up breast MRI and whether they are appropriate for such a recommendation. 12,[14][15][16][17] DeMartini et al 18 studied the impact of BPE on the diagnostic performance of breast MRI and found that increased BPE was associated with a higher abnormal interpretation rate (BI-RADS 0, 3, 4, or 5) and more likely to receive short-interval follow-up but was not related to significant differences in positive biopsy rate or cancer yield.…”

Frequency and Determinants of a Short-Interval Follow-up Recommendation after an Abnormal Screening Mammogram

“…Some other American studies reported the proportion of lesions classified as BI-RADS category 3. Even if guidelines [1,2] recommend a short-interval follow-up for all women with these lesions, some authors [8,19] reported that the proportion of women with BI-RADS category 3 who received a short-interval follow-up recommendation was low in the 90's (40.3%-51%) and seems to be increasing over time (76% for the period 1996-2001 [20] and 91% for the period 2001-2006 [21]). However, because of this variation, our results cannot be compared to those BI-RADS studies.…”