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Reproducibility of mammographic classifications for non-palpable suspect lesions with microcalcifications

¹ Department of Radiology, Martini Hospital, Locatie van Swieten, PO Box 30033, 9700 RM Groningen, ² Julius Centre for General Practice and Patient Oriented Research, Utrecht University Medical School, PO Box 85500, 3508 GA Utrecht, ³ National Expert and Training Centre for Breast Cancer Screening, University Medical Centre Nijmegen, PO Box 9101, 6500 HB Nijmegen and ⁴ Department of Radiology, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands

Observer variability in interpretation of mammograms is a well-known problem, especially for microcalcifications. The classification of the mammographic findings depends upon this interpretation. We performed an intraobserver study to evaluate a breast imaging reporting and data system (BI-RADS) based method for description and classification of non-palpable lesions with microcalcifications. A set of 100 non-palpable mammographic lesions mainly consisting of microcalcifications was described and classified on two occasions, by two radiologists at an interval of 6 months. The intraobserver variability was evaluated with kappa statistics. The overall agreement for the classification was moderate (kappa 0.54). The lowest kappa values were observed for the categories "probably benign (BI-RADS 3, kappa 0.59)" and "suspicious abnormality (BI-RADS 4, kappa 0.44)". The clinical management (follow-up or biopsy) of non-palpable lesions consisting of microcalcifications depending upon radiological classification in the groups BI-RADS 3 (follow-up) and BI-RADS 4 (biopsy) is therefore debatable.