BI-RADS Mammography Reports: Resident Guide PDF

This copy is for personal use only. To order printed copies, contact [email protected] 319...

This copy is for personal use only. To order printed copies, contact [email protected] 319 Breast Imaging | BI-RADS Terminology for Mam- mography Reports: What Resi- dents Need to Know RADIOGRAPHICS FUNDAMENTALS Karina Pesce, MD, PhD The full digital presentation is available online. María B. Orruma, MD Carolina Hadad, MD Mammography is the most widely used screening technique for Yesenia Bermúdez Cano, MD early detection of breast cancer, and it plays an important role in Roberto Secco, MD reducing breast cancer mortality. The Breast Imaging Reporting and Andrea Cernadas, MD Data System (BI-RADS) lexicon is presently the main communica- tion tool used in mammography reports in most countries that have Abbreviation: BI-RADS = Breast Imaging Re- porting and Data System established breast cancer screening programs. The BI-RADS lexicon is the compass that effectively guides radiologists throughout their RadioGraphics 2019; 39:319–320 daily practice, and it is important for radiology residents to under- https://doi.org/10.1148/rg.2019180068 stand the lexicon so that they can effectively communicate breast Content Code: imaging findings depicted at mammography. This online presenta- From the Department of Breast Radiology, Hos- tion describes the terminology used in the BI-RADS fifth edition to pital Italiano de Buenos Aires, Pres. Tte. Gral. help radiologists and trainees effectively interpret mammograms and Juan Domingo Perón 4190, Capital Federal C1199 ABB, Argentina. Presented as an educa- improve patient care. tion exhibit at the 2017 RSNA Annual Meeting. The BI-RADS lexicon in general was not intended to be a static Received March 11, 2018; revision requested May 18 and received July 1; accepted July 19. All system. Since its creation in 1993, four editions have been published, authors have disclosed no relevant relationships. in 1995, 1998, 2003, and 2013. The BI-RADS lexicon was initially a Address correspondence to K.P. (e-mail: quality assurance system used to homogenize data collected at mam- [email protected]). mographic screenings, but the BI-RADS fourth edition was adapted © RSNA, 2019 for use with US and MRI. The BI-RADS lexicon categorizes breast imaging findings into seven categories, BI-RADS categories 0 to 6. A BI-RADS category of 0 asssigned to a mammogram indicates that additional imag- ing should be obtained, while BI-RADS category 1 indicates that findings are negative for malignancy. BI-RADS categories 2 and 3 indicate benign and probably benign findings, respectively. The suspicion of malignancy increases with BI-RADS categories 4 and 5, and BI-RADS category 6 represents a biopsy-proven malignancy. The illustrative BI-RADS fifth edition is the result of years of col- laboration among subsection heads, committees, and the American College of Radiology (ACR), as well as contributions from users. Teaching Points The BI-RADS lexicon provides a systematic and efficient method to evaluate and com- municate mammographic findings, and using this system is an effective way to improve the interpretive skills of radiologists and radiology residents and fellows. If a screening mammogram interpretation indicates a concern for malignancy, the next step will generally involve performing additional imaging. A radiologist should not im- mediately recommend a procedure (eg, as in the case of a BI-RADS category 4 or 5 le- sion) after interpreting screening mammograms. Bilateral masses demonstrating significant interval growth, an increase in density, or a loss of the appearance of circumscribed margins should prompt additional diagnostic evaluation. 320 March-April 2019 radiographics.rsna.org Figure 1. Chart depicts the spectrum of benign findings seen at mammography and how these findings should be managed according to BI-RADS category 2. Figure 2. Chart depicts the diag­ nostic algorithm used for BI-RADS category 3 lesion management with follow-up at 6, 12, and 24 months. A BI-RADS category 3 le- sion should be updated to a cat- egory 2 if the lesion disappears or appears benign at 2-year follow- up. If the lesion size increases by 20% during follow-up, a BI-RADS category of 4 should be assigned. The BI-RADS structure provides a systematic Suggested Readings and efficient method to evaluate mammographic D’Orsi CJ, Kopans DB. Mammography interpretation: the BI- RADS method. Am Fam Physician 1997;55(5):1548–1550, findings and facilitate resident and breast imag- 1552. ing fellowship training. Both the ACR and the D’Orsi CJ, Sickles EA, Mendelson EB, et al. ACR BI-RADS Society of Breast Imaging recommend that breast atlas, Breast Imaging Reporting and Data System. Reston, Va: American College of Radiology, 2013. imaging education within residency and fellow- Mercado CL. BI-RADS update. Radiol Clin North Am 2014;52 ship programs should be designed to require the (3):481–487. use of BI-RADS terminology, assessment catego- Michaels AY, Birdwell RL, Chung CS, Frost EP, Giess CS. Assessment and management of challenging BI-RADS cat- ries (Fig 1), and management recommendations egory 3 mammographic lesions. RadioGraphics 2016;36(5): (Fig 2). 1261–1272. Educating radiologists and trainees on the ap- Rao AA, Feneis J, Lalonde C, Ojeda-Fournier H. Pictorial review of changes in the BI-RADS fifth edition. RadioGraphics propriate use of the BI-RADS lexicon to describe 2016;36(3):623–639. findings seen at mammography is an effective way Sickles EA, Philpotts LE, Parkinson BT, et al. American Col- to improve interpretive skills at mammographic lege of Radiology/Society of Breast Imaging curriculum for resident and fellow education in breast imaging. J Am Coll screening. Radiol 2006;3(11):879–884. Tabár L, Vitak B, Chen TH, et al. Swedish two-county trial: im- pact of mammographic screening on breast cancer mortality during 3 decades. Radiology 2011;260(3):658–663.