QA in Breast MRI Feasibility Audit of Preoperative Evaluation Under BI-RADS v2025-Podcast скачать в хорошем качестве

QA in Breast MRI Feasibility Audit of Preoperative Evaluation Under BI-RADS v2025-Podcast

Redefining Quality Assurance in Breast MRI: A Feasibility Audit of Preoperative Extent-of-Disease Evaluation Under BI-RADS v2025 The forthcoming Breast Imaging Reporting and Data System (BI-RADS) v2025 introduces, for the first time, a formal recommendation to audit preoperative breast MRI examinations performed for extent-of-disease (EOD) evaluation. In this landmark study published in Radiology, Cohen et al. evaluated the feasibility of implementing this new audit framework and reported benchmark performance metrics derived from a large tertiary cancer center cohort. Background and Rationale Dynamic contrast-enhanced breast MRI plays a critical role in staging newly diagnosed breast cancer. However, unlike screening or diagnostic MRI, preoperative MRI examinations are typically assigned BI-RADS category 6 (known malignancy) and have historically been excluded from standard audit calculations. The BI-RADS v2025 manual corrects this gap by recommending dedicated auditing of preoperative MRI, including four distinct performance metrics: Abnormal Interpretation Rate (AIR) Positive Predictive Value of Biopsies Recommended (PPV2) Positive Predictive Value of Biopsies Performed (PPV3) Additional Cancer Detection Rate (ACDR) The present study aimed to (1) test the feasibility of performing such audits, (2) publish reference metrics to stimulate benchmarking across institutions, and (3) identify clinicopathologic factors associated with malignant outcomes. Methods A retrospective review was conducted of consecutive preoperative breast MRI examinations performed between January 2021 and December 2022 at The University of Texas MD Anderson Cancer Center. Total preoperative MRI examinations analyzed: 1,533 Median patient age: 54.6 years (IQR 45.5–65.2) Suspicious BI-RADS 4/5 findings identified: 609 Image-guided biopsies performed: 432 Malignancies detected: 139 Seven fellowship-trained breast radiologists manually extracted data and performed audit calculations. Total radiologist time required: 141 hours, with a mean case audit time of approximately 1.06 minutes per case. Audit metrics were calculated overall, as well as stratified by ipsilateral and contralateral lesion location relative to the index malignancy. Key Results Overall Performance Metrics AIR: 30.3% (95% CI: 28.0–32.6) PPV2: 22.8% (95% CI: 19.5–26.1) PPV3: 32.2% (95% CI: 27.8–36.6) ACDR: 90.7 per 1000 examinations (95% CI: 74.3–107.1) Ipsilateral vs. Contralateral Differences Ipsilateral lesions demonstrated higher PPV3 (43.0%) compared with contralateral lesions (25.6%). Ipsilateral ACDR: 62.0 per 1000 Contralateral ACDR: 35.2 per 1000 These findings align with the known higher malignancy risk of lesions ipsilateral to the primary tumor. Predictors of Malignancy Multivariable analysis revealed: Older patient age (OR 1.04 per year increase; P .001) Ipsilateral lesion location (OR 1.81; P = .005) Both were significantly associated with higher odds of malignant biopsy results. Clinical and Operational Implications Feasibility Confirmed Preoperative MRI auditing is operationally feasible, though currently labor-intensive. Metrics Within Anticipated Ranges Reported values fall within previously published but heterogeneous ranges for preoperative MRI performance. Need for Workflow Adaptation The BI-RADS v2025 mandate for assigning separate BI-RADS categories for each finding represents a paradigm shift. Structured reporting systems must adapt accordingly. Automation Is Essential Manual auditing is unsustainable at scale. Integration into PACS/reporting systems and national registries such as the National Mammography Database will be critical for establishing robust benchmarks. Benchmark Interpretation Requires Context Preoperative MRI metrics should not be conflated with screening MRI benchmarks. Differences in patient population, disease prevalence, and clinical intent necessitate distinct quality thresholds. Conclusion This study provides the first comprehensive feasibility assessment of preoperative breast MRI auditing under BI-RADS v2025 and establishes reference performance metrics. The work represents a critical step toward standardized quality assurance in staging MRI, bridging a longstanding audit gap in breast imaging practice. The next frontier lies in automation, structured reporting integration, and multi-institutional benchmarking. APA (7th edition) Citation Cohen, E. O., etc.. (2025). Feasibility of auditing preoperative breast MRI for extent-of-disease evaluation using the BI-RADS v2025 manual. Radiology, 317(1), e243803. Hashtags #BreastMRI #BIRADS2025 #BreastImaging #RadiologyEducation #BreastCancer #ImagingQuality #OncologicImaging #RadiologyResearch #MedicalInnovation #StructuredReporting #CancerStaging #RadiologyExplained #RadiologyQuality #ImagingAudit #ExtentOfDisease #QualityAssurance © 2025 AI Chavelle™ by Jeffrey Chen / SmartRad AI. All rights reserved.