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Concordance of breast imaging reports with national
recommendations in Australia
Poster No.:
C-2159
Congress:
ECR 2011
Type:
Scientific Paper
Authors:
F. J. Pool , M. T. rickard , R. Perry , A. W. steinberg , J. Grimm ,
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C. Nehill ; Singapore/SG, Sydney/AU, Dee Why NSW/AU
Keywords:
Breast, Professional issues, Mammography, Ultrasound
DOI:
10.1594/ecr2011/C-2159
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Page 1 of 11
Purpose
The purpose of this study was to assess concordance of breast imaging reports
from a New South Wales community private practice setting with evidence-based
recommendations regarding the form and content of breast imaging reports developed
in 2002 by the Australian National Breast and Ovarian Cancer Centre and endorsed by
the Royal Australian and New Zealand College of Radiologists.
Background:
Breast Cancer in Australia (Figure 1):
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Breast cancer is the most common cancer in women (28% of all reported
cancer cases in women in 2006)
2,614 invasive breast cancer cases were diagnosed in women in 2006
BreastScreen Australia participation 2007-2009[1]
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1,622,481 (34%) females 40+
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1,241,796 (56.9%) females 50-69 years
Imaging of symptomatic women chiefly carried out by private providers
reimbursed by Medicare
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354,611 Mammography 2007-2008 [1]
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>800,000 breast ultrasounds 1997-1999 [2]
Recommendations about reporting of breast imaging [2]
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Major outcome of 2002 review of breast imaging by National Breast and
Ovarian Cancer Centre (NBOCC), Sydney Australia particularly by nonBreastScreen providers
Aim to improve reporting by increasing the number of breast imaging reports
with:
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all essential descriptors of significant lesions (location, size, features)
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correlation of imaging findings with clinical findings
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an imaging diagnosis
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a classification based on clinical management
Process:
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Review of best available published evidence by multidisciplinary team
Sub-group of project team developed standardised reporting and
classification system
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Reporting and classification system reviewed by members of Breast Imaging
Reference Group (BIRG) of Royal Australian and New Zealand College of
Radiologists (RANZCR)
Key Evidence:
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Checklists have been found to improve the content and completeness of
reports in pathology[2]
BIRADS, developed by the American College of Radiology has improved
the completeness of reports by identifying essential items to be included in
reports and by specifying the manner in which these items are described [2]
Key Features (Figures 2 and 3):
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Checklist format
All breast imaging reports to include reason for examination, mammographic
density (where applicable) and number of significant imaging lesions
requiring further investigation or follow-up
Mammographic density classification in %quartiles, similar to BIRADS
Significant abnormalities to follow lesion based reporting to help correlate
mammography/ ultrasound findings
The 1-5 classification system for imaging findings was developed to
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help prevent interpretation errors
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to effectively and unambiguously communicate the level of concern
between the radiologist and referring doctor
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to provide a guide to further management [2]
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Differs from BIRADS because short-term follow-up not common
in Australasia, and also differs slightly from Royal College of
Radiologists classification system [3]. (Figure 4).
Dissemination:
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Recommendations endorsed by RANZCR and first disseminated in 2002,
revised 2006.
Limited uptake in private practice anecdotally
Limited uptake in private practice confirmed on internal NBOCC Scoping
study 2006
2007 NSW audit of reports for breast cancer patients found no synoptic
reports among cases presenting with community imaging, and significant
omission of clinically important information from these reports [4]
This study:
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Audit carried out as part of 2008 NHMRC-NICS RANZCR NBOCC
Fellowship implementation project aimed at increasing uptake of The
synoptic breast imaging report.
Page 3 of 11
Images for this section:
Fig. 1: Age standardised incidence of breast cancer/100,000 females, 2002
Page 4 of 11
Fig. 2: Synoptic breast imaging report
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Fig. 3: Imaging classification 1-5
Fig. 4: Comparison of breast imaging classification systems
Page 7 of 11
Methods and Materials
Study Setting:
Audit carried out Private practice of 40+ Radiologists (including part-time/locum
radiologists) reporting breast imaging in 13 clinics
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Metropolitan north and west Sydney
NSW Central Coast
NSW regional centres
Report Collection:
625 reports were collected randomly from 1786 mammography and/or ultrasound studies
performed during April and May 2009.
Report Analysis:
Carried out after de-identification with respect to patient and radiologist.
Reports were coded according to:
Format (synoptic or free prose)
Completeness relative to recommended modality- and findings-appropriate content
items:
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For all reports: reason for examination, number of significant lesions present
For all reports except ultrasound only studies: mammographic density
For all significant lesions requiring further evaluation or follow-up: clinical
correlation, mammographic/ultrasound correlation, side, mammographic
and/or ultrasound location and features, distance from nipple, size,
diagnosis, breast imaging classification and recommendation.
Ethics approval by NSW Population & Health Services Research Ethics Committee,
reference number 2009/08/179.
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Results
625 reports collected in total. 3 excluded because they did not relate to diagnostic breast
imaging, leaving 622 reports for analysis
Study modalities:
Both mammogram and ultrasound 68%
Mammography only 5%
Ultrasound only 27%
Reason for the examination:
"Diffuse" eg lumpy breasts 20%
"Focal" 39%
None 19%
Screening 21%
Unclear 1%
None given 19%
"Diffuse" indications included lumpy breasts, mastalgia
"Focal" indications were specific lumps or nipple discharge
"Screening" outside BreastScreen Australia occurs with previous breast cancer, family
history or metastatic disease outside the breast with unknown primary
Mammographic Density (studies including mammography):
Yes: 63%
No: 37%
Number of Significant lesions:
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Explicitly reported 0%
71% reported as normal/no abnormality/ no evidence of malignancy
14% benign assessment category or diagnosis
11% indeterminate or further investigation recommended
3% lesions reported as suspicious
1% unclear
Number of significant
recommended: 106
lesions
for
which
further
investigation/follow-up
12 examinations reported 2 significant lesions
1 examination reported 3 significant lesions
For significant lesions recommended for further investigation or follow up relevant
content item completeness:
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clinical correlation 68%
side 92%
distance from nipple 73%
size 74%
diagnosis 94%
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mammographic/ultrasound correlation (where appropriate) 25%
mammographic location (where appropriate) 83%
mammographic features (where appropriate) 85%
ultrasound location (where appropriate) 90%
ultrasound features (where appropriate) 94%.
Conclusion
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There has been poor uptake of the synoptic breast imaging report despite
initial dissemination efforts. This is consistent with the findings in the internal
scoping study and the published study which focussed only on patients with
a known diagnosis of breast cancer [4].
Concordance with recommendations was lowest for number of significant
lesions present, breast imaging classification, reason for examination, breast
Page 10 of 11
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density, and clinical and ultrasound/mammographic correlation for significant
lesions.
An implementation project aimed at increasing the use of the synoptic breast
imaging report was carried out in 2009 and 2010 and is currently under
evaluation.
References
1.
2.
3.
4.
Australian Institute of Health and Welfare & National Breast and Ovarian
Cancer Centre 2009. Breast cancer in Australia: an overview, 2009. Cancer
series no. 50. Cat. no. CAN 46. Canberra: AIHW
NBCC, Breast Imaging: a guide for practice. 2002, National Breast and
Ovarian Cancer Centre: Camperdown
Maxwell AJ, Ridley NT, Rubin G, Wallis MG, Gilbert FJ, Michell MJ. The
Royal College of Radiologists Breast Group breast imaging classification.
Clin Radiol. 2009 Jun;64(6):624-7.
Houssami, N., J. Boyages, et al. (2007). "Quality of breast imaging reports
falls short of recommended standards." Breast 16(3): 271-9.
¡ More information at http://www.nbocc.org.au/view-document-details/big-2-synopticbreast-imaging-report-document-update
¡ Synoptic report available at http://www.nbocc.org.au/view-document-details/rsig-1synoptic-breast-imaging-report
Personal Information
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