The Breast Imaging Reporting and Data System (BI-RADS) is a standardized system of reporting breast pathology as seen on mammogram, ultrasound, and magnetic resonance imaging. It encourages consistency between reports and facilitates clear communication between the radiologist and other physicians by providing a lexicon of descriptors, a reporting structure that relates assessment categories to management recommendations, and a framework for data collection and auditing. This article highlights the changes made to the BI-RADS atlas 5th edition by comparison with its predecessor, provide a useful resource for a radiologist attempting to review the recent changes to the new edition, and serve as a quick reference to those who have previously become familiar with the material.

Objective: To compare the incremental cancer detection rate (ICDR) using bilateral whole-breast ultrasonography (BWBUS) vs dynamic contrast-enhanced MRI in patients with primary breast cancer. Methods: A retrospective database search in a single institution identified 259 patients with breast cancer diagnosed from January 2011 to August 2014 who underwent mammography, BWBUS and MRI before surgery. Patient characteristics, tumour characteristics and lesions seen on each imaging modality were recorded. The sensitivity, specificity and accuracy for each modality were calculated. ICDRs according to index tumour histology and receptor status were also evaluated. The effect of additional cancer detection on surgical planning was obtained from the medical records. Results: A total of 266 additional lesions beyond 273 index malignancies were seen on at least 1 modality, of which 121 (45%) lesions were malignant and 145 (55%) lesions were benign. MRI was significantly more sensitive than BWBUS (p 5 0.01), while BWBUS was significantly more accurate and specific than MRI (p , 0.0001). Compared with mammography, the ICDRs using BWBUS and MRI were significantly higher for oestrogen receptorpositive and triple-negative cancers, but not for human epidermal growth factor receptor 2-positive cancers. 22 additional malignant lesions in 18 patients were seen on MRI only. Surgical planning remained unchanged in 8 (44%) of those 18 patients. Conclusion: MRI was more sensitive than BWBUS, while BWBUS was more accurate and specific than MRI. MRIdetected additional malignant lesions did not change surgical planning in almost half of these patients. Advances in knowledge: BWBUS may be a cost-effective and practical tool in breast cancer staging.

Objective To compare conventional DWI with spectral spatial excitation (cDWI) and an enhanced DWI with additional adiabatic spectral inversion recovery (eDWI) for 3T breast MRI. Methods Twenty-four patients were enrolled in the study with both cDWI and eDWI. Three breast radiologists scored cDWI and eDWI images of each patient for fat-suppression quality, geometric distortion, visibility of normal structure and biopsy-proven lesions, and overall image quality. SNR, CNR and ADC for evaluable tissues were measured. Statistical tests were performed for qualitative and quantitative comparisons. Results eDWI yielded significantly higher CNR and SNR on a lesion and higher glandular CNR and SNR, and muscle SNR on a patient basis. eDWI also yielded significantly higher qualitative scores in all categories. No significant difference was found in ADC values. Conclusion eDWI provided superior image quality and higher CNR and SNR on a lesion basis. eDWI can replace cDWI for 3T breast DWI.

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