Dr. Mohit GoelJRIII27/2/15

BI-RADS® is designed to standardize breast imaging reporting and to reduce confusion in breast imaging interpretations.

It also facilitates outcome monitoring and quality assessment.

It contains a lexicon for standardized terminology (descriptors) for mammography, breast US and MRI.

All mammographic, ultrasound, and breast MRI findings and reports should closely adhere to the BI-RADS lexicon and assessment categories.

BIRADS

In BI-RADS 2013 the use of percentages is discouraged, because in individual cases it is more important to take into account the chance that a mass can be obscured by fibroglandular tissue than the percentage of breast density as an indicator for breast cancer risk.

The composition is c - heterogeneously dense, although the volume of fibroglandular tissue is less than 50%.The fibroglandular tissue in the upper part is sufficiently dense to obscure small masses.So it is called c, because small masses can be obscured.Historically this would have been called an ACR 2: 25-50% density.

Dense fibroglandular tissue have an increased risk of developing breast cancer, and detection of early cancer can be obscured by the fibroglandular tissue.

Bilateral interval increase in fibroglandular density is usually benign and may be caused either by hormonal effects or breast edema.

A unilateral increase in fibroglandular density is worrisome for lymphatic obstruction, which may be malignant.

Hormone therapy may cause an increase in fibroglandular density.

Pregnancy, lactation, and weight loss may all cause an interval increase in fibroglandular density.

A mammographic mass is a space-occupying lesion with convex borders seen in two different projections. In contrast, an asymmetry is seen in one view only.

Architectural distortionrepresents radiating linear densities emanating from a central point, without a definite mass visible.

Asymmetry as an area of fibroglandulair tissue visible on only one mammographic projection, mostly caused by superimposition of normal breast tissue

In the 2003 atlas calcifications were classified by morphology and distribution either as benign, intermediate concern or high probability of malignancy.

In the 2013 version the approach has changed.

Since calcifications of intermediate concern and of high probability of malignancy all are being treated the same way, which usually means biopsy, it is logic to group them together.

Calcifications are now either typically benign or of suspicious morphology

Skin calcifications are associated with sweat glands, are usually punctate or lucent-centered, and are most common medially, where the concentration of sweat glands is higher.

Arterial vascular calcifications are present in the upper portion of the image (yellow arrow), while large rod-like calcifications are present in the inferior portion of the image (red arrows).

Arterial vascular calcifications within the breast have a distinctive morphology and are typically not mentioned in the body of the report unless they are very extensive or the patient is very young

highly suspicious for malignancy. The branching distribution suggests filling of the lumen of a duct system involved by DCIS.

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