Consensus Meeting of Breast Imaging: BI-RADS® and Beyond

Abstract

Organizers of medical educational courses are often confronted with questions that are clinically relevant yet trespassing the frontiers of scientifically proven, evidence-based medicine at the point of care. Therefore, since 2007 organizers of breast teaching courses in German language met biannually to find a consensus in clinically relevant questions that have not been definitely answered by science. The questions were prepared during the 3 months before the meeting according to a structured process and finally agreed upon the day before the consensus meeting. At the consensus meeting, the open questions concerning 2D/3D mammography, breast ultrasound, MR mammography, interventions as well as risk-based imaging of the breast were presented first for electronic anonymized voting, and then the results of the audience were separately displayed from the expert votes. Thereafter, an introductory statement of the moderator was followed by pros/cons of two experts, and subsequently the final voting was performed. With ≥75% of votes of the expert panel, an answer qualified as a consensus statement. Seventeen consensus statements were gained, addressing for instance the use of 2D/3D mammography, breast ultrasound in screening, MR mammography in women with intermediate breast cancer risk, markers for localization of pathologic axillary lymph nodes, and standards in risk-based imaging of the breast. After the evaluation, comments from the experts on each field were gathered supplementarily. Methodology, transparency, and soundness of statements achieve a unique yield for all course organizers and provide solid pathways for decision making in breast imaging.

Keywords: Breast intervention; Imaging; Magnetic resonance imaging; Tomosynthesis; Tumor localization; Ultrasound.

Fig. 1

Voting results for primary tomosynthesis in symptomatic women. Panel: n = 16; audience: n = 203.

Fig. 2

Voting results for criteria of ultrasound reporting. Panel: n = 16; audience: n = 186. a D'Orsi et al. [16]. bMüller-Schimpfle et al. [17]. cMadjar et al. [18].