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. 2020 Apr;17(4):469-474.
doi: 10.1016/j.jacr.2019.10.003. Epub 2019 Oct 26.

Factors Associated With Optimal Follow-up in Women With BI-RADS 3 Breast Findings

Ronilda Lacson  1 , Aijia Wang  2 , Laila Cochon  2 , Catherine Giess  3 , Sonali Desai  4 , Sunil Eappen  5 , Ramin Khorasani  3
Affiliations

Factors Associated With Optimal Follow-up in Women With BI-RADS 3 Breast Findings

Ronilda Lacson et al. J Am Coll Radiol. 2020 Apr.

Abstract

Objective: Assess rate of and factors associated with optimal follow-up in patients with BI-RADS 3 breast findings.

Methods: This Institutional Review Board-approved, retrospective cohort study, performed at an academic medical center, included all women undergoing breast imaging (ultrasound and mammography) in 2016. Index reports for unique patients with an assessment of BI-RADS 3 (retrieved via natural language processing) comprised the study population. Patient-specific and provider-related features were extracted from the Research Data Warehouse. The Institutional Cancer Registry identified patients diagnosed with breast cancer. Optimal follow-up rate was calculated as patients with follow-up imaging on the same breast 3 to 9 months from the index examination among patients with BI-RADS 3 assessments. Univariate analysis and multivariable logistic regression determined features associated with optimal follow-up. Malignancy rate and time to malignancy detection were recorded.

Results: Among 93,685 breast imaging examinations, 64,771 were from unique patients of which 2,967 had BI-RADS 3 findings (4.6%). Excluding patients with off-site index examinations and those with another breast examination <3 months from the index, 1,125 of 1,511 patients (74%) had optimal follow-up. In univariate and multivariable analysis, prior breast cancer was associated with optimal follow-up; younger age, Hispanic ethnicity, divorced status, and lack of insurance were associated with not having optimal follow-up. Malignancy rate was 0.86%, and mean time to detection was 330 days.

Discussion: Follow-up of BI-RADS 3 breast imaging findings is optimal in only 74% of women. Further interventions to promote follow-up should target younger, unmarried women, those with Hispanic ethnicity, and women without history of breast cancer and without insurance coverage.

Keywords: BI-RADS; breast imaging; follow-up; health disparities; mammography.

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