Pacific Breast Center

LightView®
Viewer Login

» Home

» Patient Information

» Procedures

» Technology

» F. A. Q.'s

» Locations

» Contact Us

» Breast Center Info.

» Public Speaking

» Patient Testimonials

Pacific Breast Center
1500 NW Bethany Blvd.
Suite 130, Beaverton

Main Office
503.619.1150
Scheduling
503.619.1111
Beaverton Hours
M-F 8am to 5pm
Tigard Hours
T-W-Th 8:30am
to 12:30pm &
1pm to 5pm

:::: FOR OUR REFERRING PHYSICIANS : NEWSLETTER :.

Bi-Rads

Dear Colleague:

I was recently honored to speak at the Oregon Section of the American College of Obstetrics and Gynecology in Sunriver on the subject Missed and Delayed Diagnosis of Breast Cancer. I asked the audience how many of them were partly or greatly confused by the BI-RADSTM classification used in reporting mammographic findings. Easily 75% of the audience raised their hands. This was not surprising. Confusion about BI-RADSTM abounds throughout the country and is not limited to the clinical community; many radiologists are also confused as to the most appropriate designation for reporting their level of concern.

Radiologists are required under the FDA-MQSA federal regulations to report their mammographic findings under specifically defined categories, following the BI-RADSTM terminology established by the American College of Radiology. The accompanying description of BI-RADSTM categories and how we use them is intended to help you understand our final assessment of imaging findings and recommendations for follow-up or management.

If you have any questions or comments, please feel free to call me or one of my colleagues, Dr. Paul Meunier or Dr. Jane Bedell.

Sincerely,

Bill Eklund, M.D., FACR

Mammographic Reporting:
Understanding categories of concern and recommendations based on those concerns

G.W. Eklund, M.D., FACR
Medical Director, Pacific Breast Center

It is important for the clinical community to understand the breast imaging radiologist’s assessment, concern for malignancy and recommendations for follow-up or management. BI-RADSTM categories, indicating the level of concern and probability of malignancy, were developed by the American College of Radiology to reduce confusion and bring uniformity in reporting mammographic findings. Like many breast imaging facilities, we refer to “Categories” rather than specifically referring to BI-RADSTM™.

Category	Required wording	Findings and explanation	Recommendation
1	“Normal”	Normal. There are no imaging indings of concern. There may be incidental findings such as post operative changes or implants, but no benign “lesions” or focal concerns.	Return to regular screening
2	“Benign finding(s)”	There are specific or incidental abnormalities that are considered benign, but there is no suspicion for malignancy and no requirement for special attention. Typical benign lesions include cysts, fibroadenomas and some types of calcification.	Return to regular screening
3	“Probably benign”	This is most often an imaging finding considered to have a very high probability of being benign (98 %+), but previous films are not available to establish its stability; thus, reassessment in a shorter interval (usually 6 months) is advised.	Short interval follow-up with additional imaging
4	“Suspicious abnormality”	Clinicians should understand that this category may be divided into 3 very different levels of suspicion for malignancy. See subcategories below.	Biopsy
4A*	“Suspicious abnormality”	Finding has a low suspicion for malignancy.In our practice this category has less than 6% risk for being malignant; however, biopsy confirmation that it is benign is recommended.	Biopsy
4B	“Suspicious abnormality”	Finding has a moderate suspicion for malignancy.In our practice there is a 35-40% chance biopsy will show malignancy.	Biopsy
4C	“Suspicious abnormality”	Finding has a high suspicion for malignancy. In our practice over 90% of these findings will prove to be malignant.	Biopsy
5	“Highly suggestive of malignancy”	These lesions are almost certainly malignant. In our practice virtually all of these lesions will prove malignant.	Biopsy
6	Known malignancy	These are lesions that have been pathologically proven to be malignant
0	“Incomplete: Need additional imaging”	The imaging findings are inconclusive or may be artifacts of superimposition and cannot be resolved or properly characterized without additional imaging. Special mammographic views or ultrasound may be required. This category is also used if the final assessment cannot be made until previous films have been obtained and reviewed.	Return for additional imaging workup or obtain previous films for comparison.

*We believe it is inappropriate to call category 4A findings “suspicious”; however, we are required by federal mandate to do so. Our reports will state, “MQSA requires that these findings be reported as ‘suspicious’. Our level of concern for malignancy is low.”