On 13 June 2015, Dr. Markus Müller-Schimpfle will be chairing the fifth Breast Diagnostics Consensus Forum in Frankfurt, Germany. In this interview, Müller-Schimpfle, who is head of radiology, neuroradiology, and nuclear medicine at the Frankfurt-Höchst Clinic, and a partner in "Radiomedicum," a regional group practice for radiology and nuclear medicine, explains what will be happening when leading figures at the forefront of the breast care community get together.
The subject of this year's consensus forum will be "New reporting standards." What imaging methods do you plan to use?
Müller-Schimpfle: Our forum will be focusing primarily on coming to grips with the new BI-RADS lexicon, which came out in English in February 2014. This means that we will be dealing with mammography, ultrasound, and MRI scanning methods. What is special about this is that whilst the standard lexicon is a major reference work for us, we cannot take it on board exactly as it stands because we will need to match it to our own situation. Quite apart from this, we have yet to see a German-language translation.
When insurers ask who should meet the costs of a procedure, it's really useful to refer them to research presented at the consensus forum, according to Dr. Markus Müller-Schimpfle.What exactly does this mean?
Basically, we will be looking at two sets of issues. Firstly, we will need to identify new features in the BI-RADS and then pass this information on to the breast care community in the form of proposals and drafts. Secondly, we are being asked to see just how practicable this will be in Germany and, primarily, to use our own medical experience as the basis for checking it as well. We will be proposing modifications wherever we feel that they are needed.
Are you expecting the consensus within your community to move away from BI-RADS?
We are expecting to come across features on which our views here in Germany, and maybe in the rest of Europe too, will differ from those held in the U.S. breast care market. I use the term "market" deliberately because, despite Obama care, conditions within U.S. healthcare differ slightly from those in Europe. In addition to the medical options, there is also the matter of the scientific and structural conditions under which breast diagnostics are carried out. And, with all due respect, ultimately, the consensus forum process that we use in drafting recommendations is more transparent and more broadly based than that used by the people who set up the BI-RADS, which remains highly exclusive and which is not always readily comprehensible.
What is different about these conditions?
We have a great deal of experience with breast ultrasound scanning in Germany and this experience has been very widely disseminated, thanks to the efforts of the DRG (German Radiological Society) and the DEGUM (German Society for Ultrasound in Medicine), as well as to programs run by specialist gynecological societies and sickness insurers. This a peculiarity of the German system, as a result of which we, in this country, differ from our U.S. counterparts in the way in which we consider not only pretest probability factors and female risk constellations, but also the far more critical subject of "Who benefits from early ultrasound detection?"
The consensus forum will be getting together for the fifth time. What has the forum actually achieved for breast diagnostics since it was founded?
The 2007 forum definitely had a real impact upon the issue of microcalcifications. In 2011, the consensus forum really pushed the case for MRI diagnostics in at-risk female patients, as well as for allowing differentiated consideration during presurgical diagnostics.
In 2013, we were able to compile a composite picture of the status of all the different methods. At that time -- and I would like to state this openly -- we were already looking ahead to the new version of the BI-RADS, which we are now, at last, able to debate.
Apart from that, I am really happy that, time and again, consensus forum results are making their mark in postgraduate training papers. Something else that I am seeing -- and I have no hesitation in urging colleagues to do this -- is that when sickness insurance medical departments raise queries with us as to who should be meeting costs, it is extremely useful to be able to refer to the forum paper! Only recently, I heard that one insurer had decided quite spontaneously to refer to it.
For further information and registration for the meeting, click here.
Editor's note: This article is an edited version of a translation of an article published in German online by the German Radiological Society (DRG, Deutsche Röntgengesellschaft). Translation by Syntacta Translation & Interpreting.
