Question

Discuss the BIRADS assessment categories. Give two examples of breast lesions/diseases under each assessment category.

Answer 1

BIRADS scoring means Breast imaging and Reporting and Database system score.It is a scoring system to describe mammogram results.

There are 6 categories in BIRADS assessment

Category 0

*It needs additional imaging or prior examinations.

*Risk of malignancy cannot be assessed in this category

Category 1-negative

*It confirms that mammogram result is negative

*There is no benign lesions,no cancer,and breasts are of equal density

*Routine sreening should be continued.

Category 2-Benign

*Benign cyst or mass is present

Eg:round opacities with microcalcifications,fatty densities or partially fatty images

*Risk of malignancy is 0%

*Routine screening should be continued

Category 3- Probably benign

*Risk of malignancy is 0-2%

*Follow up should be done every 6 months

Eg: clusters of tiny calcifications,non calcified solid nodules which are round,ovoid and well defined

Category 4- suspicious

*There are 3 additional categories in category 4.

4A.low suspicion for malignancy(3-10%)

4B.moderate suspicion for malignancy(11-50%)

4C.high suspicion for malignancy(51-94%)

Eg: asymmetric localised hyperdensities with convex contours, round or oval noncystic opacities with microlobulated or obscured contours,fibrocystic changes

*Management is tissue diagnosis

Category 5-high suspicion of malignancy

*There is at least a 95%chance for malignancy

Eg: typically malignant microcalcifications,poorly circumscribed opacities with ill defined and irregular contours

*Management is tissue diagnosis

Category 6-known biopsy(proven malignancy)

*This category is assigned only if biopsy has been done and diagnosis of breast cancer is received.

Eg:invasive ductal carcinoma,Inflammatory breast cancer

*Management is surgical excision, chemotherapy or surgery