Bi-rads

Les mando lo acordado sobre bi-rada:

BI-RADS mammographic assessment categories

Assessment category Recommendation Probability of malignancy
1: Negative Routine follow-up 0 percent
2: Benign Routine follow-up 0 percent
3: Probably benign Short interval follow-up <2 percent
4: Suspicious Consider biopsy 2 to 75 percent
5: Highly suggestive of malignancy Appropriate management >75 percent
0: Incomplete Further imaging evaluation Not applicable


BI-RADS: Breast Imaging Reporting and Data System.




BI-RADS System — The degree of abnormality seen on the initial screening mammogram is categorized using the BI-RADS system (Breast Imaging Reporting and Data System). The BI-RADS system is related to the chance of breast cancer [43]; within any BI-RADS category, the probability of a cancer diagnosis increases with age [44].

The BI-RADS categories are as follows : BI-RADS 0 (Incomplete): Perform spot compression and magnification mammography views or ultrasonography as soon as possible. BI-RADS 1-2 (benign): Routine follow-up.

BI-RADS 1 refers to breasts that are symmetric with no masses, architectural distortion, or suspicious calcifications. No abnormalities are present.

BI-RADS 2 refers to breasts with benign abnormalities. Mammographic findings may include involuting, calcified fibroadenomas; multiple secretory calcifications; fat-containing lesions such as oil cysts; lipomas; galactoceles; and mixed-density hamartomas; all of which have characteristically benign appearances and may be labeled with confidence [45]. The interpreter may also choose to use this category to describe intramammary lymph nodes, vascular calcifications, implants or architectural distortion clearly related to prior surgery.

Calcifications that are not suspicious for malignancy, and considered benign include vascular and skin calcifications, rim-like calcifications, large coarse calcifications, and smooth round or oval calcifications. BI-RADS 3 (Probably benign): Perform diagnostic mammography of the breast that has the abnormality in six months.

BI-RADS 3 lesions have a low likelihood of malignancy [46-48]; in one series, only three of 141 lesions (2 percent) were malignant, and all were DCIS [46]. A finding placed in this category is not expected to change over the follow-up interval, but the radiologist would prefer to establish its stability over time. Three specific findings are described as being "probably benign": the noncalcified mass, focal asymmetry, and a cluster of round [punctate] calcifications; however, the latter is anecdotally considered by some radiologists to be an absolutely benign feature [45].

It is important that all patients with abnormalities classified as BI-RADS 3 receive the recommended follow-up. The vast majority of findings in this category will be managed with an initial short-term follow-up (six months) examination followed by additional examinations until longer-term (2 years or longer) stability is demonstrated. Two studies have found that women advised to have 6-month follow-up mammograms reported relatively high anxiety levels compared to women with immediate work up of abnormal mammograms [49,50]. BI-RADS 4 (Suspicious) and 5 (Highly suggestive of malignancy): TA tissue diagnosis is needed. Perform core needle or excisional biopsy as soon as possible. (See "Diagnostic evaluation and initial staging work-up of women with suspected breast cancer").

BI-RADS 4 is reserved for findings that do not have the classic appearance of malignancy but have a wide range of probability of malignancy that is greater than those in Category 3. While intervention is indicated for all BI-RADS category 4 lesions, this category has been further stratified into low, intermiediate and moderate to high risk, designated as 4a, b, and c respectively.

BI-RADS 5 refers to lesions with a high probability of being cancer, such as a spiculated mass or malignant-appearing pleomorphic calcifications. In data from the Breast Cancer Surveillance Consortium, biopsies in women with screening mammograms that were BI-RADS 5 revealed invasive cancer in 69 percent of patients age 40 to 49 years and in 89 percent (n = 370) of patients age 70 to 79 [44].

A BI-RADS designation of 4c or 5 should alert the pathologist that a malignant diagnosis is strongly suspected, and that further evaluation of the specimen may be needed if the biopsy is initially interpreted as benign.