The Importance of Radiology and Pathology Communication in the Diagnosis and Staging of Cancer: Mammography as a Case Study. 4.2 High clinical volume and existence of extensive breast cancer guidelines

11/01/2010

The number of mammograms performed annually in the US is estimated at approximately 36.7 million mammograms. 9 These mammograms result in approximately one million image-guided breast biopsies per year. 10-12 Current guidelines by the American College of Radiology (ACR) stipulate that radiologists are required to use standardized terminology such as Breast Imaging Reporting and Data System (BI-RADS®) under the Mammography Quality Standards Act (MSQA) of 1992 13 to help standardize mammography practice. This standard provides a clear set of terms and definitions for the breast imaging process and a mandatory set of final assessment categories to indicate level of certainty with respect to abnormal findings. It also includes a small set of actionable conclusions, oriented toward decision making with the highest level of certainty defined as Known Biopsy-Proven Malignancy-Appropriate Action Should Be Taken. Note that this highest level of certainty is dependent on the radiologist receiving confirmation of biopsy results. Breast cancer is unique in that the use of standardized terminology for unambiguous reporting of mammographic results such as BI-RADS is required by law under MQSA. MQSA guidelines also require that if a biopsy is performed, then radiologists must make an attempt to correlate the results of the biopsy with the mammogram findings. 13 This degree of specificity is not required in reporting the findings of other types of malignancies.

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