BI-RADS FOR MAMMOGRAPHY AND ULTRASOUND 2013

1. Dr. SUMIT KUMAR
RADIOLOGY PG II

2. 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.

8. 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.

10. 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.

11. 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.

15. 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.

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

21. Architectural distortion represents radiating linear densities emanating from a
central
point, without a definite mass visible.

23. 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

25. 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.

26. 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

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

42. BIRADS

53. THANK YOU