What is the risk of malignancy and care plan for each BI-RAD category?

Updated: Oct 17, 2016
  • Author: Nagwa Dongola, MD, FRCR; Chief Editor: Peter Eby, MD  more...
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Answer

Each BI-RADS level has an appropriate management or follow-up plan associated with it. For example, if a referring doctor sees a mammogram report with a category 3 assigned to it, he or she knows the recommendation is for the woman to undergo follow-up mammography in 6 months.

If used correctly and consistently, each BI-RADS category has the risks of malignancy and the associated plan of management or follow-up shown in Table 1 below.

Table 1. Risk of malignancy and care plan by BI-RADS category (Open Table in a new window)

Category

Description

Risk of Malignancy

Care Plan and Comments

1

Negative

5 in 10,000

Continue annual screening mammography for women 40 years of age or older.

2

Benign finding, noncancerous

5 in 10,000

Continue annual screening mammography for women 40 years of age or older. This category is for cases with a characteristically benign finding (eg, cyst, fibroadenoma).

3

Probably benign finding

< 2%

Usually, 6-month follow-up mammography is performed. Most category 3 abnormalities are not evaluated with biopsy.

4

Suspicious abnormality

25-50%

Most category 4 abnormalities are benign but may require biopsy.

5

Highly suggestive of malignancy

75-99%, depending on how individual radiologists define categories 4 and 5

Classic signs of cancer are seen on the mammogram. All category 5 abnormalities are typically evaluated with biopsy; if the results are benign, repeat biopsy is done to ensure correct sampling.


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