US of Breast Masses Categorized as BI-RADS 3, 4, and 5: Pictorial Review of Factors Influencing Clinical Management

Abstract

The Breast Imaging Reporting and Data System (BI-RADS) lexicon for ultrasonography (US) is based on the established lexicon used successfully in mammography and attempts to provide a common language to avoid ambiguity in interpreting, reporting, and teaching breast US. Proper and consistent use of the BI-RADS US lexicon has numerous advantages, including facilitating (a) communication of final assessment categories that clearly indicate management recommendations, (b) data tracking for self-audits, and (c) clinical review of outcome summaries. However, the literature to date does not include sufficient data on outcomes to validate clinical use of the BI-RADS US lexicon. In this article, a pictorial review of the BI-RADS US lexicon descriptors is provided, and specific cases from a retrospective review are used to highlight the challenges in using the BI-RADS US lexicon. With these examples, suggestions are offered for greater clarity in the use of this lexicon. The technical challenges in follow-up US imaging are described. The challenges in assigning final assessment categories are detailed, as well as the clinical factors that may influence decision making and the management of certain lesions.

Assessment of breast lesions using BI-RADS US lexicon in mammographically dense breasts (ACR categories 3 and 4) with histopathological correlation

“…BI-RADS US lexicon is still less widely used than is the BI-RADS lexicon for mammography because it is still in its early editions (7). According to the analysis of the BI-RADS US descriptors, and based on BI-RADS US assessment categories, the breast lesions in this study were classified into 5 BI-RADS US categories (from 1 to 5), where BI-RADS US category 1 represents negative findings, 2 represents benign lesions, while 3 stands for the probably benign ones, 4 is the suspicious malignant lesions and lastly 5 is for the highly suggested malignant lesions (7).…”

“…The retro-areolar region was separately scanned with angled views to ensure the complete coverage of all breast tissue. The detected breast lesions were localized by the clock face method and were categorized as normal, probably benign, benign, suspicious for malignancy or malignant based on BI-RADS US assessment categories (7). The US lexicon includes six morphologic features of solid breast masses: shape, orientation, margin, lesion boundary, internal echo pattern, and posterior acoustic features according to BI-RADS US descriptors (7).…”

BI-RADS categorisation of 2708 consecutive nonpalpable breast lesions in patients referred to a dedicated breast care unit

“…Table 3) Secondly, previous studies were impaired by small sample size [19], or retrospective design [20,21]. Others were limited because they are performed only on surgical biopsies [2,3,22] -a technique disappearing over time-, or because these studies evaluated a single biopsy technique, (VAAB [23][24][25] or core needle biopsy [21,26]) , or a single breast abnormality (mass [14,24] or microcalcifications [27] ). As opposed to the latter, our report concerns patients who have been referred to our dedicated breast care unit by community physicians and does not describe the experience of a single radiology unit.…”

“…Additionally, there can still be substantial interobserver variability in its application [8][9][10][11][12]. Of note, BI-RADS, though useful, remains a radiological classification, and does not take into account detailed previous history, prognosis and clinical factors that may also widely influence management [13,14]. In France, in 2002, the 4 th American BI-RADS lexicon for mammography was translated into French by the Health Authority (HAS, former ANAES).…”

US follow-up protocol in concordant benign result after US-guided 14-gauge core needle breast biopsy

“…Regarding follow-up protocol of concordant benign lesion after US-guided 14-gauge CNB, the lesion should be followed up with US because the follow-up imaging modality should be the one that best demonstrates the lesion [1]. The timing for US follow-up can be 6, 12, 18 (optional), and 24 months, for at least 2 years of stability after CNB [18], based on the widely validated use of mammographic follow-up for probably benign lesion [15][16][17]. However, it is not certain that the follow-up protocol for probably benign lesions that was detected mammographically can be adopted into concordant benign CNB results, as it is.…”