Concordance of BI-RADS Assessments and Management Recommendations for Breast MRI in Community Practice.

OBJECTIVE: The purpose of this study was to evaluate concordance between BI-RADS assessments and management recommendations for breast MRI in community practice. MATERIALS AND METHODS: Breast MRI data were collected from four regional Breast Cancer Surveillance Consortium registries from 2005 to 2011 for women who were 18-79 years old. Assessments and recommendations were compared to determine concordance according to BI-RADS guidelines. Concordance was compared by assessment category as well as by year of examination and clinical indication. RESULTS: In all, 8283 MRI examinations were included in the analysis. Concordance was highest (93% [2475/2657]) in examinations with a BI-RADS category 2 (benign) assessment. Concordance was also high in examinations with category 1 (negative) (87% [1669/1909]), category 0 (incomplete) (83% [348/417]), category 5 (highly suggestive of malignancy) (83% [208/252]), and category 4 (suspicious) (74% [734/993]) assessments. Examinations with categories 3 (probably benign) and 6 (known biopsy-proven malignancy) assessments had the lowest concordance rates (36% [302/837] and 56% [676/1218], respectively). The most frequent discordant recommendation for a category 3 assessment was routine follow-up. The most frequent discordant recommendation for a category 6 assessment was biopsy. Concordance of assessments and management recommendations differed across clinical indications (p < 0.0001), with the lowest concordance in examinations to assess disease extent. CONCLUSION: Breast MRI BI-RADS management recommendations were most concordant for assessments of negative, incomplete, suspicious, and highly suggestive of malignancy. Lower concordance for assessments of probably benign and known biopsy-proven malignancy and for examinations performed to assess disease extent highlight areas for interventions to improve breast MRI reporting.