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Lost in narration: Do we need to improve the quality of breast imaging reporting in Australia?

Radiologists are now able to make a judgement on this matter, with consideration of recent evidence from an audit of imaging reports of women with breast cancer treated in a multidisciplinary institution in New South Wales (NSW). The NSW Breast Cancer Institute (BCI) study has shown gaps in the quality of reports relative to national recommendations. The key findings from this research are summarized in Table 1. These relate to the use of synoptic and structured reporting, the standard for breast imaging reporting, as opposed to traditional narrativestyle reporting. Reports from BreastScreen (BS) were much more likely to comply with national standards on this issue and structured reporting correlated to the provision of more complete information. None of the community-based radiology (CBR) reports used (or incorporated) a synoptic or structured format and CBR reports were generally more likely to omit key items of information (Table 1). Narrative-style reporting (without an element of synopsis, structure or correlation of imaging lesions) provides description and allows discussion of differential diagnoses, but may leave the ‘end-user’ with the task of interpreting partially communicated information. Some of the decision-making is thus shifted to the end-user, magnifying the potential for error in the complex diagnostic context of breast disease. Irrespective of whether the end-user is the referring general practitioner or a specialist, ambiguous reporting will (at best) cause unnecessary additional testing and referral and it may potentially contribute to delays in breast cancer diagnosis. Structured and synoptic reporting requires a greater level of commitment on the part of the radiologist: the radiologist has the responsibility of doing the interpreting and the correlation and is required to be clear and definitive in the way this is communicated (while allowing room for equivocal imaging findings). From an international perspective, the Breast Imaging Reporting and Data System (BI-RADS) developed by the American College of Radiology has been in use for over a decade, and is an established universal system for structured reporting of breast imaging. Despite the interpretation variability associated with any structured and categorical reporting system, BI-RADS has been widely adopted by American radiologists and applied elsewhere in the world, in an effort to standardize and improve the way breast imaging findings are communicated between health professionals and across varying settings. It has also facilitated evaluation and audit of breast imaging procedures and clinical research in breast diagnosis. Why has the story taken a different turn in Australia? In 2002, the National Breast Cancer Centre and the RANZCR jointly introduced a guide for the reporting of breast imaging developed for the Australian context. The key aspects of the guide are summarized in a recently re-released version as Table 1. Key findings of the Breast Cancer Institute study of breast imaging reports in New South Wales