Breast Imaging Report and Data System (BIRADs)
Article by Assoc. Prof. Dr. Youwanush Kongdan and Dr. Paweena Lueadthai
Breast cancer screening through mammograms and ultrasounds is widespread today. However, interpreting the results on your own can be challenging due to the specialized terminology. Physicians must explain the results and provide management guidelines. This article aims to simplify the interpretation of screening results for self-understanding.
Findings in Radiologist Reports
Cysts
Cyst or Simple Cyst: Indicates a fluid-filled sac; generally not a cause for concern.
Complicated Cyst: May contain some solid material; requires monitoring.
Intracystic Mass: A mass within a cyst; may indicate malignancy and needs careful evaluation.
Cysts are not cancerous or tumors. Previously classified as a type of breast disease, they are now understood as part of normal hormonal changes during the menstrual cycle. Cysts can form from residual changes in the breast tissue after ovulation.
Calcification
Microcalcification: Tiny calcium deposits (<0.5 mm) that can be benign or malignant.
Macrocalcification: Larger calcium deposits (>0.5 mm), typically benign.
Microcalcifications, especially when clustered or following a linear branching pattern, may suggest breast cancer and require further investigation.
Masses
Benign vs. Malignant: Benign masses have well-defined borders, while malignant masses may have ill-defined, lobulated, irregular, or spiculated borders.
Increased Vascularization: Indicates increased blood supply, which could be due to inflammation or cancer.
BIRADs Reporting System
The Breast Imaging Reporting and Data System (BIRADs) standardizes the reporting of mammogram and ultrasound findings, developed by the American College of Radiology (ACR). It helps in communicating results, understanding risks, and planning appropriate care.
BIRADs Categories
Each BIRADs category reflects different levels of concern and management recommendations:
BIRADs 0 – Incomplete
Explanation: Requires additional imaging, such as further mammograms or ultrasounds.
Management: Follow up as recommended by the radiologist.
BIRADs 1 – Negative
Explanation: No abnormalities detected.
Cancer Probability: 0%
Management: Routine screening as scheduled (typically every 1-2 years).
BIRADs 2 – Benign
Explanation: Findings like cysts or benign lumps.
Cancer Probability: 0%
Management: Routine screening as scheduled (typically every 1-2 years).
BIRADs 3 – Probably Benign
Explanation: Findings are likely benign but should be monitored.
Cancer Probability: ≤2%
Management: Follow-up every 6 months to 1 year until stable.
BIRADs 4 – Suspicious Abnormality
Explanation: Findings have a higher risk of being cancerous and need further investigation.
Subcategories:
BIRADs 4A: Low suspicion (2-10%)
BIRADs 4B: Moderate suspicion (10-50%)
BIRADs 4C: High suspicion (50-95%)
Management: Biopsy recommended to confirm diagnosis.
BIRADs 5 – Highly Suggestive of Malignancy
Explanation: High likelihood of cancer.
Cancer Probability: >95%
Management: Immediate additional testing and planning for treatment, such as biopsy and further management.
BIRADs 6 – Known Biopsy-Proven Malignancy
Explanation: Cancer confirmed by biopsy.
Cancer Probability: 100%
Management: Proceed with cancer treatment plan, including surgery, radiation, or chemotherapy.
Summary
BIRADs provides a clear framework for reporting and managing breast imaging results, ensuring effective communication and appropriate care. Consult with a physician for personalized advice and management based on your BIRADs category.
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