Reclassification of Mammographic Reports After Breast Ultrasound Using the Bi-Rads System

Abstract

INTRODUCTION: For the year 2012, more than 52, 680 new cases of breast cancer and a mortality of 12, 852 women are estimated in Brazil. Breast cancer is diagnosed early by the radiological examination of mammography because of its 90, 0% sensitivity. However, currently, the results of reports and the quality of examinations are highly criticized; revelations and images of poor quality; reports that do not follow the Bi-rads system, thereby increasing false negative results. The Bi-rads system was created in order to standardize the findings and radiological reports. Mammography is complemented with other radiological examinations; the Ultrasound; whenever there is any doubt on mammography or clinical examination. MATERIAL AND METHODS: Patients were referred to the Ambulatory of breast benign pathologies in the city of Marilia due to the results of Bi-rads mammographies 0, I, II and III from 2008 to 2011. Mammographies were requested by professionals in primary health care and they were performed in the radiology services of Marilia. The Mammography Reports were reclassified using the Bi-rads system, after the completion of breast ultrasound. All patients with Bi-rads mammographic reports 0 to III underwent breast ultrasound; the ones with Bi-rads I and II underwent Ultrasound when presenting alterations in clinical examinations. The ultrasound device used is TOSHIBA Nemio XG, with breast probe of 7, 5 to 11, 5 Hz. Only one Mastologist performed the ultrasound examinations. RESULTS: Total assessed mammographic reports: Bi-rads 0 – 1116, Bi-rads I – 54, Bi-rads II – 151 and Bi-rads III – 58. Following breast ultrasound, reports were reclassified and results were the following: Bi-rads I – 337; Bi-rads II – 706; Bi-rads III – 263; Bi-rads IV – 72 and Bi-rads V – 1. There was a correlation between Bi-rads I in 35. 0%, Bi-rads II in 61. 0%, and Bi-rads III in 27. 0%. Bi-rads 0 was so reclassified: Bi-rads I – 273 (24, 92%), Bi-rads II – 571 (51. 0%), Bi-rads III – 212 (19. 0%), Bi-rads IV – 59 (5. 0%) and Bi-rads V – 1 (0. 08%). CONCLUSIONS: The biggest problem is still Bi-rads 0 because supplementation with ultrasound is always necessary. After reclassification, the vast majority showed benign results (I – 24. 92% and II – 51. 0%), probably benign (III – 19. 0%) and a very small percentage of suspected categories (IV – 5. 0% and V – 0. 08%). This indicates that most of the Bi-rads 0 results are benign. Thus, they should be better interpreted, because they generate a high number of complementary examinations. We had a low correlation between Bi-rads I (35. 0%) and Bi-rads III (27. 0%); in Bi- rads II (61. 0%) results were high indicating accordance only in this category.