BI-RADS Classification for Management of Abnormal Mammograms

Margaret M. Eberl, MD, MPH; Chester H. Fox, MD; Stephen B. Edge, MD; Cathleen A. Carter, PhD; Martin C. Mahoney, MD, PhD, FAAFP

Disclosures

J Am Board Fam Med. 2006;19(2):161-164. 

In This Article

Clinical Vignettes to Illustrate Clinical Management Using BI-RADS Codes

Case 1

A 48-year-old female had a screening mammogram showing rounded densities with possible irregular borders amid dense breast tissue bilaterally.

Radiologic Interpretation: BI-RADS 0 (additional imaging needed). One week later, she had spot compression views that showed the nodules to be regular and sharply defined. Ultrasound examination revealed cysts. Final classification as BI-RADS 2 (benign finding). Patient should continue with routine breast cancer screening.

Case 2

A 57-year-old female completed a screening mammogram showing calcifications in the right breast. These lesions were confined to the upper outer quadrant but were scattered and round on magnification views. The only prior mammogram was from 4 years ago, was of poor quality, and only showed a few scattered calcifications.

Radiologic Interpretation: BI-RADS 3 (probably benign). Despite the lack of a recent prior comparison mammogram, the current calcifications were felt to be of low suspicion. During a discussion the patient was informed that the calcifications were felt to be of low suspicion. A repeat mammography was recommended in 6 months. Follow-up mammogram at 6 months and subsequently at 1 year showed no change in these calcifications.

Case 3

A 53-year-old female had a screening mammogram that showed linear calcifications clustered tightly in the upper outer quadrant of the right breast. Magnification views confirmed these were clustered and that there was no associated mass. The calcifications were not present on a mammogram obtained 12 months earlier.

Radiologic Interpretation: BI-RADS 4 (suspicious abnormality). Results were reviewed with the patient and biopsy was recommended. Vacuum-assisted needle biopsy (Mammotome) was performed using mammographic stereotactic localization. Pathology showed atypical ductal hyperplasia. Subsequent excisional biopsy confirmed the absence of malignancy.

Case 4

A 62-year-old female completed a screening mammogram showing a 1-cm spiculated mass with associated calcifications lateral to the left nipple area. This lesion was not present on prior mammograms.

Radiologic Interpretation: BI-RADS 5 (highly suspicious of malignancy). Results were reviewed with the patient, and needle biopsy was recommended. Vacuum-assisted needle biopsy (Mammotome) was performed using mammographic stereotactic localization. Pathology showed infiltrating ductal carcinoma, grade II.

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