Mapeamento da utilização do Breast Imaging Reporting and Data System (BI-RADS®) na ultrassonografia no Brasil
Data
2024-11-26
Autores
Merjane, Vanessa 
Orientadores
Iared, Wagner
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: O BI-RADS® é uma ferramenta de qualidade criada pelo ACR. Denominado sistema por conter um léxico, estrutura de relatórios e coleta de dados / monitoramento de resultados. A US é um dos principais métodos de diagnóstico de doenças mamárias, junto com mamografia, RM e biópsia guiada por imagem. Objetivos: O objetivo principal desta pesquisa é mapear o uso do BI-RADS® na US no Brasil. Os objetivos secundários buscam investigar o perfil dos médicos que utilizam o BI-RADS®, avaliar sua dinâmica de trabalho e identificar problemas e particularidades na prática diária da US mamária no país que possam influenciar a utilização desse sistema. Métodos: Aplicado questionário on-line e individual a uma amostra de médicos. A divulgação do link, com 58 perguntas de múltipla escolha, foi realizada entre setembro/2022 e fevereiro/2023, em congressos médicos, redes sociais e e-mails cadastrados nas entidades: Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, Sociedade Brasileira de Mastologia, Federação Brasileira das Associações de Ginecologia e Obstetrícia, Sociedade Brasileira de Ultrassonografia e Associação Médica Brasileira. Todos os dados foram submetidos a análise estatística descritiva por meio de frequências absolutas e relativas, utilizando-se o software R. Resultados: Foram analisadas respostas de 686 médicos de todos os estados brasileiros e Distrito Federal, sendo 355 (51,7%) da Região Sudeste, 398 (58,0%) com atuação nas capitais/região metropolitana, 417 (60,8%) mulheres e 241 (35,1%) entre 31-40 anos, sendo 293 (42,7%) formados há mais de 20 anos. Do total, 348 (50,7%) atuam exclusivamente no setor privado, 31 (4,5%) no setor público e 307 (44,8%) nos dois setores, sendo que 577 (84,1%) atuam a maior parte do tempo no privado. Destacamos que 282 (41,1%) não fizeram residência reconhecida pela Comissão Nacional de Residência Médica. Entre os 588 médicos (85,7%) com Título de Especialista, identificamos 279 (40,7%) com especialização específica em Radiologia e Diagnóstico por Imagem. Entre os respondentes, 364 (53,1%) atuam exclusivamente com US, ou seja, não realizam outro método de imagem da mama. Apesar de 99,1% dos médicos afirmarem utilizar o BI-RADS® na prática diária, sobre a forma de como utilizam o sistema nos relatórios, apenas 360 (52,5%) afirmaram sempre colocar a indicação do exame e 355 (51,8%) sempre incluir recomendação de conduta. Em relação ao monitoramento dos resultados, apenas 66 (9,6%) afirmaram que são realizadas auditorias institucionais com comprovação histopatológica dos casos. Do total de respondentes, 238 médicos (34,7%) afirmaram trabalhar sem acesso a um Picture Archiving and Communication System (PACS). A maioria dos médicos, 526 (76,7%), trabalha em sistema de agenda mista, que envolve outros tipos de exames ultrassonográficos, que não a US mamária, e 267 (38,9%) respondentes afirmaram trabalhar em instituições onde não há obrigatoriedade da realização da mamografia antes da US, quando os dois exames são solicitados juntos. Conclusões: O estudo destaca que o BI-RADS® é amplamente utilizado pelos médicos – que realizam US mamária no Brasil – que têm compreensão da sua responsabilidade individual. A falta de aplicação de critérios necessários para a sua utilização na US indicam fragilidades na implementação do sistema no contexto brasileiro. Além disso, verificamos heterogeneidade e fragmentação do ensino médico, das habilidades profissionais e da rotina de trabalho destes médicos que aplicam o BI-RADS®, o que pode contribuir para inconsistências na implementação e uso do sistema na prática clínica.
Introduction: The Breast Imaging Reporting and Data System (BI-RADS®), developed by the American College of Radiology, is designed to standardize breast imaging reports and data collection. It consists of three main components: a lexicon, report structure, and data collection framework. Breast ultrasound (US) is one of the primary diagnostic tools for breast disease, alongside mammography, magnetic resonance imaging (MRI), and image-guided biopsy. Objectives: The primary objective of this study is to map the use of BI-RADS® in breast ultrasound across Brazil, emphasizing its role in early breast cancer diagnosis and screening programs. Special attention is given to the structuring of medical reports and the monitoring of diagnostic outcomes. Additionally, this study aims to explore the specific profiles of physicians utilizing BI-RADS® in their practice, as well as their experiences and perceptions, to identify challenges and specificities within the Brazilian context that may impact the use of this system. Methods: An online survey consisting of 58 multiple-choice questions was administered to a sample of physicians. The survey was distributed from September 2022 to February 2023 via medical conferences, social media platforms, and email lists from organizations such as the Brazilian College of Radiology and Diagnostic Imaging, the Brazilian Society of Mastology, the Brazilian Federation of Gynecology and Obstetrics Associations, the Brazilian Society of Ultrasound, and the Brazilian Medical Association. Results: Responses from 686 physicians, representing all Brazilian states and the Federal District, were analyzed. Of these, 355 (51,7%) were from the Southeast region, 398 (58,0%) worked in metropolitan areas, 417 (60,8%) were female, and 241 (35,1%) were between the ages of 31-40 years, with 293 (42,7%) having graduated over 20 years ago. A total of 348 (50,7%) worked exclusively in the private sector, 31 (4,5%) in the public sector, and 307 (45%) in both sectors, with 577 (84,1%) reporting that most of their work was in private practice. Additionally, 282 (41,1%) reported that they had not completed a residency accredited by the National Medical Residency Commission. Among the 588 physicians (85,7%) who held specialist certifications, 279 (40,7%) were identified as having specific training in Radiology and Diagnostic Imaging. Among the respondents, 364 (53,1%) work exclusively with ultrasound, that is, they do not perform any other breast imaging method. While 99,1% of respondents indicated they use BI-RADS® in their daily practice, only 360 (52,5%) consistently included exam indications in their reports, and 355 (51,8%) always provided recommendations for follow-up. Regarding quality monitoring, only 66 (9,6%) reported that their institutions conducted audits with histopathological confirmation of cases. Furthermore, 238 physicians (34,7%) indicated they lacked access to a Picture Archiving and Communication System (PACS). Most respondents, 526 (76.7%), reported working within a mixed appointment system that includes other ultrasound modalities besides breast ultrasound, and 267 (38.9%) noted working at institutions where mammography was not required prior to a breast ultrasound. Conclusions: The study highlights that BI-RADS® is widely used by physicians – who perform breast ultrasound in Brazil – who understand their individual responsibility. The lack of application of necessary criteria for its use in ultrasound indicates weaknesses in the implementation of the system in the Brazilian context. In addition, we found heterogeneity and fragmentation in medical education, professional skills and work routine of these physicians who apply BI-RADS®, which may contribute to inconsistencies in the implementation and use of the system in clinical practice.
Introduction: The Breast Imaging Reporting and Data System (BI-RADS®), developed by the American College of Radiology, is designed to standardize breast imaging reports and data collection. It consists of three main components: a lexicon, report structure, and data collection framework. Breast ultrasound (US) is one of the primary diagnostic tools for breast disease, alongside mammography, magnetic resonance imaging (MRI), and image-guided biopsy. Objectives: The primary objective of this study is to map the use of BI-RADS® in breast ultrasound across Brazil, emphasizing its role in early breast cancer diagnosis and screening programs. Special attention is given to the structuring of medical reports and the monitoring of diagnostic outcomes. Additionally, this study aims to explore the specific profiles of physicians utilizing BI-RADS® in their practice, as well as their experiences and perceptions, to identify challenges and specificities within the Brazilian context that may impact the use of this system. Methods: An online survey consisting of 58 multiple-choice questions was administered to a sample of physicians. The survey was distributed from September 2022 to February 2023 via medical conferences, social media platforms, and email lists from organizations such as the Brazilian College of Radiology and Diagnostic Imaging, the Brazilian Society of Mastology, the Brazilian Federation of Gynecology and Obstetrics Associations, the Brazilian Society of Ultrasound, and the Brazilian Medical Association. Results: Responses from 686 physicians, representing all Brazilian states and the Federal District, were analyzed. Of these, 355 (51,7%) were from the Southeast region, 398 (58,0%) worked in metropolitan areas, 417 (60,8%) were female, and 241 (35,1%) were between the ages of 31-40 years, with 293 (42,7%) having graduated over 20 years ago. A total of 348 (50,7%) worked exclusively in the private sector, 31 (4,5%) in the public sector, and 307 (45%) in both sectors, with 577 (84,1%) reporting that most of their work was in private practice. Additionally, 282 (41,1%) reported that they had not completed a residency accredited by the National Medical Residency Commission. Among the 588 physicians (85,7%) who held specialist certifications, 279 (40,7%) were identified as having specific training in Radiology and Diagnostic Imaging. Among the respondents, 364 (53,1%) work exclusively with ultrasound, that is, they do not perform any other breast imaging method. While 99,1% of respondents indicated they use BI-RADS® in their daily practice, only 360 (52,5%) consistently included exam indications in their reports, and 355 (51,8%) always provided recommendations for follow-up. Regarding quality monitoring, only 66 (9,6%) reported that their institutions conducted audits with histopathological confirmation of cases. Furthermore, 238 physicians (34,7%) indicated they lacked access to a Picture Archiving and Communication System (PACS). Most respondents, 526 (76.7%), reported working within a mixed appointment system that includes other ultrasound modalities besides breast ultrasound, and 267 (38.9%) noted working at institutions where mammography was not required prior to a breast ultrasound. Conclusions: The study highlights that BI-RADS® is widely used by physicians – who perform breast ultrasound in Brazil – who understand their individual responsibility. The lack of application of necessary criteria for its use in ultrasound indicates weaknesses in the implementation of the system in the Brazilian context. In addition, we found heterogeneity and fragmentation in medical education, professional skills and work routine of these physicians who apply BI-RADS®, which may contribute to inconsistencies in the implementation and use of the system in clinical practice.
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Citação
MERJANE, Vanessa. Mapeamento da utilização do Breast Imaging Reporting and Data System (BI-RADS®) na ultrassonografia no Brasil. Tese (Doutorado em Ciências da Saúde Baseada em Evidências) – Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2024.