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BI-RADS stands for 'breast imaging reporting and data system', and was established by the American College of Radiology. BIRADS is a scheme for putting the findings of mammograms, (for breast cancer diagnosis), into a small number of well-defined categories. Although BIRADS started out only for mammograms, it was later adapted for use with MRI and ultrasound as well. BIRADS is something that benefits the radiologists who report mammograms (and MRI and US). It doesn't do anything directly useful for patients or for the doctors who referred a patient for breast imaging. What benefit do radiologists get? The benefit to radiologists, is that it forces them to think about which category their findings will fit into, and when they assign each case into a category, then it becomes possible to calculate accuracy statistics. The accuracy statistics are generally calculated once a year, and they inform the radiologist about whether they are doing a good job, or not. This will re-assure the good radiologists to keep doing whatever they are doing, but for radiologists whose accuracy statistics aren't good, it lets them know that they ought to get more training. BIRADS classification is not a formal requirement for most radiologists to use, but most do. Another benefit of BIRADS to radiologists, that has indirectly benefitted everyone else, is that the categorization scheme has helped to standardize the words used in mammographic reporting, and this has reduced the confusion and improved communication betweem radiologists, patients, and physicians. BI-RADS classifcations have also helped in monitoring breast cancer treatment and supporting breast cancer research, again by making statistics easier to calculate. A woman is usually normally not told of the BI-RADS assessment directly. However, if you do encounter these terms, it may be useful to know what they mean.
4-suspicious abnormality, 5-highly suspicious of malignancy, 6-known biopsy with proven malignancy.
After the initial breast cancer screening, a follow-up or 'diagnostic' mammogram is often recommended when the BI-RADS category was 3 or higher. By a vast majority, most breast cancer screening mammograms are classified as either BI-RADS 1 or BI-RADS 2, and those categories don't imply any further worries.
The postive predictive value (for confirmed breast cancer) increases at BI-RADS category 4
Up to 9% of breast cancer screening mammograms will be given a BI-RADS category of 3, 4 or 5, which implies that something needs further concern. It turns out that BIRADS 3 is rarely used nowadays, because BIRADS 4 and 5 are categories that lead to biopsies, and biopsies give "definitive" answers, whereas BIRADS 3 often causes a 6-month follow-up mammogram, which leads to some "uncertainty" for everyone during those 6 months. Both radiologists and patients prefer fast answers rather than waiting 6 months. If a mammogram is classified into the BI-RADS category 3, it tends to have a very low positive predictive value (less than 2%), meaning a low chance of cancer. A BI-RADS category 4 mammogram has a positive predictive value of about 30%, and a category 5 mammogram are almost certainly predictive of breast cancer, with a positive predictive value of about 95%.
the ultrasound result "completes the BIRADS" and assigns a category 2 to the case, because a cyst is benign.
Category 1. Negative.
With category 1 the breast cancer screening mammogram shows no grouped or suspicious microcalcifications, no well-formed mass, a symmetrical glandular structure, and no change from any previous exam.
Category 2, benign
Category 2 is a definitely benign finding, and a routine screening. That is, something is found, but it is not breast cancer or malignant in any way. BI-RADS category 2 findings often include: 1. Round opacities with macrocalcifications (typical calcified fibroadenoma or cyst) 2. Round opacities corresponding to a typical cyst at ultrasonography 3. Oval opacities with a radiolucent center 4. Fatty densities or partially fatty images (lipoma, galactocele, oil cyst, hamartoma ) 5. Surgical scar 6. Scattered macrocalcifications (fibroadenoma, cyst, cytosteatonecrosis, secretory ductal ectasia); 7. Vascular calcifications 8. Breast implants,silicone granuloma.
This microcalcification is round but the edges are not sharply defined. It would be called 'indeterminate BI-RADS 3 and not BIRADS 2, because of the poorly defined, fuzzy edge.
The postive predictive value (the chance of having a real breast cancer) is very low for BI-RADS category 3 lesions, and it has actually decreased in recent years. With advances in research and experience, the PPV of a category 3 breast lesions in now considered less than 1%.
The positive predictive value (the chance of a real cancer) of BI-RADS 4 mammograms, is thought to be in the order of 20-40%.
BI-RADS category 4C has quite a high positive predictive value for breast cancer
BI-RADS category 4 is now broken in to sub-categories A, B, and C. In terms of the positive predictive value for breast cancer, a category 4A mammogram is quite low at 13%, and category 4B also moderately low at about 36%. But when we see a mammogram classefied as 4C, the positive predictive value of breast cancer jumps up to around 79%.
about 21% of the time, and only 10% of the time with category 4A breast lesions. In terms of the frequency of the subcategories of BI-RADS 4, is may be suggested that category 4A is seen about 50% of the time, 4B about 38% of the time, and category 4C only about 13% of the time. The most common confirmed diagnostic finding in BI-RADS category 4, generally, is actually fibrocystic change, at about 28%. DCIS is confirmed about 23% of the time, with columnar cell change and fibroadenoma found in about 19% of cases.
BI-RADS mammogram classifications are not intended as diagnostic tools, but only a means of standardizing communications and helping to indentify situations where follow-up is required, and the most appropriate type of follow-up. The fastest and most economical way to arrive at a positive or confirmed diagnosis of breast cancer is by core-biopsy. References 1. Obenauer S, Hermann KP, Grabbe E. Applications and Literature Review of the BI-RADS Classification. Eur Radiol (2005) 15: 1027-1036. 2. Siegmann KC, Wersebe A, Fischmann A, Fersis N, Vogel U, Claussen CD, Muller-Schimpfle M (2003). Stereotactic vacuum-assisted breast biopsy-success, histologic accuracy, patient acceptance and optimizing the BI- RADS-correlated indication. Fortschr Rontgenstr 175: 99-104. 3. Orel SG, Kay N, Reynolds C, Sullivan DC (1999) BI-RADS categorization as a predictor of malignancy. Radiology 211: 845-850. 4. Liberman L, Abramson AF, Squires FB, Glassman JR, Morris EA, Dershaw DD. The breast imaging reporting and data system: positive predictive value of mammographic features and final assessment categories. AJR Am J Roentgenol (1998); 171: 3540 5. Lacquement MA, Mitchell D, Hollingsworth AB (1999). Positive predictive value of the breast imaging reporting and data system. J Am Coll Surg 189: 34-40. 6. Eberl MM, Fox CH, Edge SB, Carter CA, Mahoney MC. BI-RADS classification for management of abnormal mammograms.J Am Board Fam Med.( 2006) MarApr;19(2):161-4. 7. Poplack SP, Tosteson AN, Grove MR, Wells WA, Carney PA. Mammography in 53,803 women from the New Hampshire mammography network. Radiology (2000); 217: 83240.
8. Monticciolo DL, Caplan LS. The American College of Radiologys BI-RADS 3 classification in a nationwide screening program: current assessment and comparison with earlier use. Breast J (2004); 10: 10610. 9. Bent CK, Bassett LW, D'Orsi CJ, Sayre JW. The positive predictive value of BIRADS microcalcification descriptors and final assessment categories. AJR Am J Roentgenol. (2010 May);194(5):1378-83. 10. Hauth, E., Umultlu, L., Kummel, S., Kimmig, R., Forsting, M. Follow-up of Probably Benign Lesions (BI-RADS 3 category) in Breast MR Imaging. The Breast Journal ( May/June 2010) Volume 16, Issue 3, pages 297304 11. Rosen, EL, Smith-Foley, SA., DeMartini, WB., Eby, PR. Peacock, S. Lehmen, CD. BI-RADS MRI enhancement characteristics of ductal carcinoma in situ. The Breast Journal ( 2007) Volume 13, p. 545-550. 12. Varas X, Leborgne JH, Leborgne F, Mezzera J, Jaumandreu S, Leborgne F.Revisiting the mammographic follow-up of BI-RADS category 3 lesions. AJR Am J Roentgenol. (2002 Sep) ;179(3):691-5. 13. Raza S, Goldkamp AL, Chikarmane SA, Birdwell RL. US of breast masses categorized as BI-RADS 3, 4, and 5: pictorial review of factors influencing clinical management.Radiographics.( 2010 Sep);30(5):1199-213. 14. Burnside ES, Ochsner JE, Fowler KJ, Fine JP, Salkowski LR, Rubin DL, Sisney GA.Use of microcalcification descriptors in BI-RADS 4th edition to stratify risk of malignancy. Radiology. (2007 Feb) ;242(2):388-95. 15. Sanders, MA., Lane, R., Sunati, S. Clinical Implications of Subcategorizing BIRADS 4 Breast Lesions associated with Microcalcification: A RadiologyPathology Correlation Study. The Breast Journal (January/February 2010) Volume 16, Number 1, , pp. 28-31. Home