Auditing preop MRIs is feasible under upcoming BI-RADS recommendations

By: Amerigo Allegretto

From: auntminnie.com

Using the upcoming version of BI-RADS for auditing preoperative breast MRI is feasible, according to research published October 14 in Radiology.

A team led by Ethan Cohen, MD, from The University of Texas M.D. Anderson Cancer Center in Houston also reported that going by the soon-to-be-released BI-RADS manual resulted in metrics that were within expected ranges based on limited prior data.

“Automation of this process is essential to develop the robust benchmarks necessary for preoperative breast MRI quality assurance,” the Cohen team wrote.

The BI-RADS version 2025 manual will recommend auditing breast MRI exams performed to evaluate the extent of disease in newly diagnosed breast cancer cases. The proposed audit includes four calculations: abnormal interpretation rate (AIR), positive predictive value of biopsies recommended (PPV2), positive predictive value of biopsies performed (PPV3), and additional cancer detection rate.

While prior studies have estimated these metrics for preoperative MRI, the researchers noted a lack of data that included all four of the recommended audit calculations.

Cohen and colleagues studied the feasibility of the proposed audit by using preoperative breast MRI exams performed in 2021 and 2022. They also reported the calculated metrics and identified any clinical or imaging characteristics tied to improved MRI performance metrics.

The study included 1,533 preoperative MRI exams with a median patient age of 55. Of the total exams, 464 showed 609 suspicious breast imaging findings. Image-guided biopsy that followed for 432 of these findings revealed 139 malignancies.

The team reported the following:

• The overall abnormal interpretation rate was 30.3%, PPV2 was 22.8%, PPV3 was 32.2%, and the additional cancer detection rate was 90.7 per 1,000 exams.

• Seven radiologists spent a combined total of 141 hours collecting data and performing audit calculations.

• Older patient age (odds ratio, 1.04; p < 0.001) and presence of lesions ipsilateral to the index malignancy (odds ratio, 1.81; p = 0.005) were associated with higher odds of malignancy.

The results highlight the need for preoperative MRI exams to be easily identifiable to allow for large-scale auditing, the study authors highlighted.

“We recommend adding a ‘Preoperative [or Staging] MRI’ label to the examination title in the medical record, imaging report, or both to facilitate accurate selection,” they wrote.

The authors also called for standardized definitions for preoperative MRI and for excluding MRI exams staging other breast malignancies from the audit. They also wrote that automating the auditing process “is the first step toward establishing reliable benchmarks for preoperative MRI audits.”

Read the full study here.