Benign breast disease: An audit of imaging classification in the symptomatic service

An audit to assess breast imagers' grading of findings on mammography and breast ultrasound in cases of proven benign breast disease, in the symptomatic breast service.

It is as important to ensure we are not overscoring benign disease, as it is to make sure we are not underscoring malignancy. Standardisation of breast imaging reports are facilitated by a classification advised by the Royal College of Radiologists Breast Group [1]. Benign breast disease should be scored a 1 or 2 and in cases of uncertainty a score of 3 should be given. There is no universally accepted target and local targets may need to be agreed. We would suggest that at least 90% of benign breast disease should be scored on imaging as 1-3 (with the majority 1 or 2) and that 95% may be achievable.

The standard: 

All symptomatic breast imaging reports should have a numerical score and most benign breast disease should score 1 or 2.

Target: 

• 100% of breast imaging examinations should have a score in the report

• a minimum of 90% or more cases of benign breast disease presenting through the symptomatic service should have an overall imaging report score of 1-3, with a target of 95%

Indicators: 

Percentage of reports containing numerical score and a percentage of benign breast disease scored 1-3.

Data items to be collected: 

• Use pathology database to identify symptomatic service benign breast biopsies

• Review radiology reports for these cases on RIS

Suggested number: 

Sample size will depend on practice - 100 cases is a reasonable sample size.

• Multidisciplinary review of all benign disease scored 4 or 5 on imaging - this review process should include pathology type and review of images

• Review team use of scoring categories

• Re-audit subsequent batch of cases

- RIS records

- Pathology database

- Time: 5hrs

1. A. J. Maxwell: The Royal College of Radiology Breast Group Imaging Classification, Clinical Radiology (2009) 64, 624-627 https://www.ncbi.nlm.nih.gov/pubmed/19414086

2. AMA Taylor K, Britton P, O'Keeffe S, Wallis MG. Quantification of the UK 5-point breast imaging classification and mapping to BI-RADS to facilitate comparison with international literature. Br J Radiol. 2011;84(1007):1005-10.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3473699/#!po=32.1429

3. Britton et al, Measuring the accuracy of diagnostic imaging in symptomatic breast patients: team and individual performance. Br J Radiol. 2012 Apr;85(1012):415-22. Epub 2011 Jan 11. https://www.ncbi.nlm.nih.gov/pubmed/21224304

Dr Joanna Powell. Updated by K A Duncan