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DOI:10.2214/AJR.06.5090
AJR 2006; 187:W557
© American Roentgen Ray Society

BI-RADS Lexicon Reemphasized

Carl J. D'Orsi and Ferris M. Hall

Emory Healthcare Emory University Medical Center Atlanta, GA
Beth Israel Deaconess Medical Center and Harvard Medical School Boston, MA



 
WEB—This is a Web exclusive article.

We enjoyed the article by Alexander et al. [1] titled "Association of Stellate Mammographic Pattern with Survival in Small Invasive Breast Tumors." However, we have some concern about the authors' use of terminology that does not conform to the terminology outlined in the BI-RADS lexicon [2]: specifically, their terms "stellate" rather than "spiculated" in describing masses and "crushed stone" rather than "pleomorphic" in describing calcifications. Indeed, both these terms were specifically discussed and finally rejected by the initial multidisciplinary BI-RADS committees when a consensus lexicon was first developed in the early 1990s.

Since the first edition of the BI-RADS lexicon was published in 1992, it has been accepted by all official breast cancer organizations and by virtually all radiologists in the United States. Today, most radiologists throughout the world use BI-RADS or some close variation. The lexicon is currently in its 4th edition [2], and the current BI-RADS committee is chaired by one of us.

The benefits of standardized terminology apply equally to all of medicine and science. They are particularly relevant to radiology because of the increasing use of worldwide teleradiology and voice recognition. Because no governing body can dictate our use of language, a major problem with teaching or applying standard lexicons is having them widely accepted [3]. BI-RADS has gained this acceptance in large part through its use in journals, books, and even examinations. However, the use of nonstandard terminology remains all too common in imaging journals, even when, as in the case of the article by Alexander et al. [1], the authors refer to BI-RADS in their text.

BI-RADS for mammography has come a long way in 14 years, and we hope the multiple other developing imaging terminologies, including the recently created BI-RADS US and BI-RADS MRI lexicons, will benefit from some of its lessons. We particularly encourage authors, editors, and journals to use these standard lexicons.


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  1. Alexander MC, Yankasas BC, Biesemier KW. Association of stellate mammographic pattern with survival in small invasive breast tumors. AJR 2006; 187:29 -37[Abstract/Free Full Text]
  2. American College of Radiology. Breast Imaging Reporting and Data System (BI-RADS), 4th ed. Reston, VA: American College of Radiology, 2003
  3. Hall FM. The language of the radiology report: primer for residents and wayward radiologists. AJR 2000;175 : 1239-1240[Free Full Text]

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