Validity of the breast imaging reporting and data system BI-RADSTM for clinical mammography in men

Aim: The implementation of diagnostic standards enhances quality assurance. The American College of Radiology's breast imaging-reporting and data system (BI-RADSTM) is intended to standardize terminology in the mammography report, the assessment of the findings, and the recommendation af action to be taken. The purpose of this study was to assess the value of the standardized system for clinically apparent male breast tumors. Do the special male anatomy and physiology limit the applicability of an evaluation system designed for female screening mammograms? Methods: 4 investigators with different degrees of experience retrospectively evaluated 160 male mammograms. Our study was based on the 36 cases which could be correlated to histopathological findings: gynecomastia in the majority of cases, but also 4 invasive ductal carcinoma, 1 leiomyosarcoma and 1 ductal carcinoma in situ. Results: Assessment of the mammograms by BI-RADSTM (3rd Edition 1998) correctly placed all cases of malignancy into categories 4 and 5 without respect to the investigators's level of experience. Conclusion: Therefore, we conclude that the BI-RADSTM-classification can successfully be used to classify male mammograms with a high positive predictive value for malignancy. Knowledge of gender-specific imaging characteristics increases the specificity at a constant high level of sensitivity. (orig.)