Final Assessment
What is a final assessment?
The final assessment is the overall evaluation made by the interpreting physician that considers all imaging series completed to determine whether the patient has breast cancer or not. The final assessment is determined by the interpreting physician, who uses all imaging/testing results of a patient. According to the FDA’s Mammography Quality Standards Act, “the final assessment is useful for evaluating woman-level screening outcomes and may be viewed as more patient-centered compared to radiologist performance measures that only consider the initial assessment based on screening views only. Final assessment should also be used when evaluating diagnostic or surveillance mammography” (FDA Breast Cancer Surveillance Consortium).
What outcomes are possible for a final assessment?
According to the Breast Cancer Surveillance Consortium, the possible outcomes for a final assessment are:
- BI-RADS 1: Negative
- BI-RADS 2: Benign
- BI-RADS 3: Probably Benign
- BI-RADS 4: Suspicious
- BI-RADS 5: Highly Suggestive of Malignancy
What is the difference between an initial and final assessment?
An initial assessment is made before any additional imaging is completed. The initial assessment is more important for evaluating radiologic performance. The final assessment may include additional imaging and/or testing to finalize the patient’s outcome.
When is an assessment considered a “final” assessment?
An assessment is considered the final assessment when the interpreting physician decides that the evaluation is complete and the resulting outcome is the one that reveals the overall results of the patient’s imaging.
How is a final assessment’s outcome determined?
The outcome of a final assessment is determined by the interpreting physician, who evaluates all imaging series and/or biopsy results completed for a patient. The physician reviews all evidence and determines what BI-RADS category the patient meets, which is input as the final assessment.
Why is a final assessment not allowed to be categorized as BI-RADS 0?
A final assessment cannot be qualified as BI-RADS 0, as this evaluation means that additional imaging is required to make a final assessment. When no final assessment category can be assigned, the FDA’s Mammography Quality Standards Act states that an evaluation of “Incomplete - Needs Additional Imaging” can be assigned for further imaging evaluation. The interpreting physician must state why no final assessment can be made.
Sources:
FDA Breast Cancer Surveillance Consortium. (2021). BCSC Standard Definitions, Version 3. https://www.bcsc-research.org/application/files/6916/1429/6964/BCSC_Data_Definitions_v3__2020.09.23.pdf