Alternate Clinical Audit, incorporating screening Birads 3

With version 5 release of Birads, ACR has requested screening audits for performance for; MG, MRI and US.
The ACR new data structure has a minimum similarities compared to historical reports (4SA).
Below is the sample format conforming new reporting.
Selectors are offered for Screening; Mammography, MRI and US.
Additional group filters added for facilities to analyze practice data by; 3D/2D MG, breast density, age, sex.

• Mammography (can combine); digital 2D, digital 3D, film 2D
• Ultrasound (can combine); automated, complete
• Age selectors (can combine); up to 39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70 up
• Density selectors (can combine); fatty, fibroglandular, hetero dense, extremely dense, unspecified
• Sex selectors (can combine); male, female

Final Birads determined by exam within 7 months from screen date (facilitates 6 month Birads 3 follow-ups)

Form A. BASIC CLINICALLY RELEVANT AUDIT, SCREENING CASES ONLY

1. Total screening exams =
1a. Scrn exams birads 0/3 =
1a1. Scrn exams with birads 0/3 where final (diagnostic) birads 4/5 =
1b. Scrn exams with birads 4/5 =
2. Scrn exams with final (scrn or diag) birads 4/5 with bx results =
2a. Scrn exams with final (scrn or diag) birads 4/5 with bx results malignant =
2b.Scrn exams with final (scrn or diag) birads 4/5 with bx results benign =
3. Scrn exams with final (scrn or diag) birads 4/5 with surgical biopsy results =
3a. Scrn exams with final (scrn or diag) birads 4/5 with surgical biopsy results malignant =
3b. Scrn exams with final (scrn or diag) birads 4/5 with surgical biopsy results benign =
4. Scrn exams with final (scrn or diag) birads 4/5 with no data on tissue diagnosis (lost) =
5. Scrn exams with final (scrn or diag) birads 4/5 with ductal carcinoma in situ =
6. Scrn exams with final (scrn or diag) birads 4/5 with invasive ductal or lobular carcinoma =
6a. Scrn exams w/final (scrn or diag) 4/5 w/invasive ductal or lobular carcinoma, and axillary nodal data =
6a1. Scrn exams w/final (scrn or diag) 4/5 w/invasive ductal or lobular carcinoma, and axillary nodal negative =
6a1a. Screening exams included in 6a1, with tumor size < 2 cm =
6a1b. Screening exams included in 6a1, with tumor size < 1 cm =

Form B. BASIC CLINICALLY RELEVANT AUDIT, SCREENING CASES ONLY

TP number of True Positives = 2a + 3a
False Positives FP1 (positive screening assessment) = (1a + 1b) – TP
False Positives FP2 (tissue diagnosis recommended) = 2b + 3b + 4
False Positives FP3 (biopsy performed) = 2b + 3b
Positive Predictive Value PPV1 (positive screening assessment) = TP / (TP + FP1)
Positive Predictive Value PPV2 (tissue diagnosis recommended) = TP / (TP + FP2)
Positive Predictive Value PPV3 (biopsy performed) = TP / (TP + FP3)
Cancer Detection Rate = (TP / 1) x 1000
Percent Invasive Cancers that are node-negative = (6a1 / 6a) x 1000
Percent Minimal Cancers (node-negative invasive cancers <1 cm, or DCIS) = ([5 + 6a1b] / TP) x 100
Percent Stage 0 or I Cancers (node-negative invasive cancers <2 cm, or DCIS) = ([5 + 6a1a] / TP) x 100
Abnormal Interpretation (Recall) Rate = ([1a + 1b] / 1) x 100

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