Using BI-RADS Terminology in Mammogram Report

The correct use of BI-ARDS terminology in a mammogram report is very important for an effective diagnosis of breast cancer. The American College of Radiology (ACR) has come up with the Breast Imaging Reporting and Data System (BI-RADS) to describe mammogram findings and results in a standard way. This system involves final assessment category which provides clear communication of the overall results to both primary care physicians and radiologists so that appropriate follow-up is performed for suspicious findings. With this, breast cancer can be correctly diagnosed at an early stage and appropriate treatment and care provided.

While Medicaid and Medicare offer coverage for mammogram screening, the accuracy of mammogram report is important and so is the use of appropriate BI-RADS categories. Here are the BI-RADS categories and what they refer to.

BI-RADS Categories (X-ray Assessment Is Not Complete)

Category 0: Additional imaging evaluation and/or comparison to prior mammograms are needed.

This actually means that a possible abnormality may not be found or defined, and more tests (for example, spot compressions) are required. This category also suggests that the mammogram results should be compared with older results to check whether there have been any changes in the area over time.

BI-RADS Categories (X-ray Assessment Is Complete)

Category 1: Negative

This indicates the breast look the same with no masses, distorted structures or suspicious calcifications and thereby suggests that no significant abnormality was found.

Category 2: Benign (non-cancerous) finding

Though this is also a negative mammogram result, the reporting doctor chooses to describe benign finding as benign calcifications, lymph nodes in the breast, or calcified fibroadenomas so that others looking at the report won’t misinterpret the finding as suspicious. This is recorded in order to help when comparing with future mammograms.

Category 3: Probably benign finding

This means a very high chance (more than 98%) for the findings being benign or not cancer. Though the findings are not expected to change over time, it is helpful to check whether the area in question does change over time. Follow-up in a short time frame is suggested for this finding. Typically, follow-up with repeat imaging is done in 6 months and regularly after that till the finding is known to be stable (at least 2 years), which helps to avoid unnecessary biopsies and still allows for early diagnosis if the area does change over time.

Category 4: Suspicious abnormality

The findings in this category do not definitely appear as cancer, but could be a cancer. A biopsy may be recommended in this case. Since the findings can have a wide variety of suspicion levels, some doctors further divide this category into the following.

•    4A: finding with a low suspicion of being cancer
•    4B: finding with an intermediate suspicion of being cancer
•    4C: finding of moderate concern of being cancer, but not as high as Category 5

Category 5: Highly suggestive of malignancy

The findings in this category look like cancer and there is at least 95% chance of it being cancer. Biopsy is required in this case and appropriate action must be taken.

Category 6: Known biopsy-proven malignancy

This is used for the findings that have already been shown to be a cancer in a previous biopsy. This category is used to see how well the cancer is responding to treatment.

BI-RADS Classification of Breast Density

An assessment of breast density will also be included in mammogram reports. The fifth edition of BI-RADS Atlas issued by the ACR in 2014 included changes in breast density reporting categories which are:

•    BI-RADS 1: The breast is almost entirely fat
•    BI-RADS 2: There are scattered areas of fibroglandular density
•    BI-RADS 3: The breasts are heterogeneously dense, which can obscure small masses
•    BI-RADS 4: The breasts are extremely dense, which lowers the sensitivity of mammography

This will improve breast density assessment which is crucial to identify women who may benefit from supplemental imaging to improve the early diagnosis of cancer.

Mammograms can also find cancers and cases of ductal carcinoma in situ or DCIS (a noninvasive tumor in which abnormal cells that may transform into cancer build up in the lining of the breast ducts) that will never cause any symptoms or are fatal. If they are not correctly reported in the mammogram report using appropriate BI-RADS category, it may lead to over-diagnosis of breast cancer and overtreatment which may prove hazardous to women. So, whether the physicians themselves prepare the report or seek help from a transcription service to save time, it is vital to make sure that the mammogram findings are reported with the most appropriate BI-RADS category.

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