Information Applicable to All Algorithms
Breast Cancer Diagnostic Algorithms for Primary Care Providers
(Third Edition, June 2005)
Radiologic Definitions (BI-RADS®)
Mammographic Results
Mammograms should only be performed in facilities certified under the Mammography
Quality Standards Act (MQSA) with FDA accreditation. As an MQSA certified facility,
all mammographic imaging results are required to be reported using the Breast Imaging
Reporting and Data System (BI-RADS®). This is a standardized system for reporting
categories of imaging results. ACR has developed BI-RADS® for Ultrasound and MRI
reporting as well (First Editions-2003).
Learn more by reading the BI-RADS® Atlas on the ACR website.
|
| Category 0 |
Need Additional Imaging Evaluation and/or Prior Mammograms for
Comparison. Category 0 is a screening mammogram result indicating
that additional imaging evaluation is needed. The additional imaging may include
spot compression, magnification, special mammographic views and/or ultrasound.
Category 0 may be assigned in situations where the current films need to be compared
with prior films, however it should only be used for old film comparisons when such
comparison is required to make a final assessment. PCPs
should follow-up with radiology facilities for the final diagnostic imaging evaluation
result if they receive a report describing a BI-RADS® 0 result. |
| Category 1 |
Negative. There is nothing to comment on. The breasts are
symmetric and no masses, architectural distortion or suspicious calcifications are
present. |
| Category 2 |
Benign Finding(s) . Like "negative"
this is a "normal" assessment, but the interpreter chooses to describe a benign finding
in the report. |
| Category 3 |
Probably Benign Finding—Initial Short-Interval
Follow-up Suggested. A complete diagnostic imaging evaluation
should be made before assigning a Category 3 result, thus it cannot be issued
as the result of a screening mammogram alone. The vast majority of patients with
Category 3 results are referred for an initial short-term follow-up (6 months)
followed by additional clinical and radiographic examinations until longer-term
(2 years or longer) stability is demonstrated. A finding placed in this category
should have less than a 2% risk of malignancy. |
| Category 4 |
Suspicious Abnormality—Biopsy Should Be Considered.
This category is reserved for findings that do not have the classic appearance of
malignancy but have a probability of malignancy that is greater than those in Category 3. |
| Category 5 |
Highly Suggestive of Malignancy —
Appropriate Action Should Be Taken. These lesions have a high
probability (>95%) of being cancer. This category contains lesions for which
one-stage surgical treatment could be considered without preliminary biopsy.
However, current oncologic management may require percutaneous tissue sampling as,
for example, when sentinel node imaging is included in surgical treatment or when
neoadjuvant chemotherapy is administered at the outset. |
| Category 6 |
Known Biopsy-Proven Malignancy—Appropriate Action Should Be
Taken. This category is reserved for lesions identified on the
imaging study with biopsy proof of malignancy prior to definitive therapy. This
category has been added for breast findings already known to be malignant by biopsy
but prior to definitive therapies such as surgical excision, radiation therapy,
chemotherapy or mastectomy. Radiologists use this for giving second opinions on
outside films with known cancers or following tumor response in neoadjuvant
chemotherapy settings. |
Learn more by reading the BI-RADS® Atlas for Mammography on the ACR website.
Posted: February, 2006. |
