BIRADS cassification is done for the breast patients to classify their risks of breast cancer.

1. BIRADS CLASSIFICATION
OF BREAST
PRESENTED BY
DR KANTA DEY

2. • The standardized system of reporting breast cancer risk is called the Breast
Imaging Reporting and Data System (BI-RADS). It was developed by the American
College of Radiology and is a numerical scale ranging from 0 to 6 that is used
in mammogram, breast ultrasound, and breast magnetic resonance imaging (MRI)
reports. These screening and diagnostic tests help determine BI-RADS score.

3. Classification
• Breast imaging studies are assigned one of seven assessment categories:
• BIRADS 0
• BIRADS 1
• BIRADS 2
• BIRADS 3
• BIRADS 4
• BIRADS 5
• BIRADS 6

4. BIRADS 0
• Incomplete
• need additional imaging evaluation (additional mammographic views or ultrasound)
• for mammography, obtaining previous images not available at the time of reading
CATAGORY MANAGEMENT LIKELIHOOD OF
Need additional imaging
or Prior examination
Recall for additional
imaging and /or await
Prior examination
N/A

5. • This patient presented with a mass on the
mammogram at screening, which was
assigned as BI-RADS 0 (needs additional
imaging evaluation).

6. BIRADS 1
• Negative
• symmetrical
• no masses, architectural distortion, or suspicious calcifications
CATAGORY MANAGEMENT LIKELIHOOD OF
Negative Routine screening 0%

7. • The breasts are symmetric and no masses, architectural distortion or suspicious calcifications are
present

8. • Image showing usg of a normal breast where fibrous connective tissue (Cooper ligaments)
arranged in a honeycomb-like structure surrounding the breast ducts and fat

9. • Image shows Fatty replaced breast,no tissue lympgadenopathy is seen.Normal
breast on MRI.

10. BIRADS 2
• Benign
• 0% probability of malignancy
CATAGORY MANAGEMENT LIKELIHOOD OF
Benign Conservative or surgical 0%

11. • BI-RADS Category 2: Mass seen on mammogram proved to be a cyst.

12. • A well-defined, anechoic, ovoid lesion with posterior acoustic enhancement Shown in ultrasonogram suggestive of simple breast cyst

13. • This MRI image shows well circumscribed lesions suggestive of simple breast
cyst,BIRADS grade 2

14. BIRADS 3
• probably benign
• <2% probability of malignancy
• short interval follow-up suggested
CATAGORY MANAGEMENT LIKELIHOOD OF
CANCER
Probably benign Short interval
follow up (less than
6 months) or
regular surveillance
More than 0% but
less than or equal
to 2 %

15. • (A) image shows a circumscribed mass at baseline screening mammography in a 40-year-old
woman due to a biopsy-confirmed fibroadenoma. (B) Targeted transverse ultrasound image
shows a circumscribed hypoechoic mass, a BI-RADS 3 finding.

16. BI-RADS 3 Lesion With Malignant Biopsy Results on
Follow-up. Forty-one-year-old Woman Undergoing
Baseline High Risk screening Breast MRI. (A) MRI of
Right Breast including MIP (Top Left), T2 STIR (Top
Right), T1 Fat-Saturated Post contrast
3 Assessment Assigned. At 6-Month Follow-up MRI
Examination, mass was Stable; However, (B) 12-
Month Follow-up MRI
Reveals Increased Size, Irregular Shape, and
Spiculated Margins of Posterior Right Breast mass in
Addition to Anterior Right diagnosed as inflitrated
ductal carcinoma

17. BIRADS 4
• suspicious for malignancy2-94% probability of malignancy
• for mammography and ultrasound, these can be further divided:
• BI-RADS 4A: low suspicion for malignancy (2-9%)
• BI-RADS 4B: moderate suspicion for malignancy (10-49%)
• BI-RADS 4C: high suspicion for malignancy (50-94%)
• biopsy should be considered
• Management :tissue diagnosis

18. • Adenosis classified as BI-RADS 4A
• A.Ultrasound revealed a solid irregular
hypoechoic mass.
• B.Image contoured manually

19. • A rounded mass with irregular & spiculated margin and
several internal micro-calcifications is noted at upper
outer quadrant of left breast which is suspicious for
cancer (BI-RADS category 4c).

20. • Image showing Invasive ductal cancer in a 46-year-
old woman in the lateral right breast. A-E, There is
an asymmetric segmental clumped nonmass
enhancement (arrows) classified correctly as
suspicious (BI-RADS 4) in DCE-MRI.

21. BIRADS 5
• highly suggestive of malignancy
• >95% probability of malignancy
• Management:
• Tissue diagnosis and appropriate action should be taken

22. • Mammogram shows pleomorphic
microcalcifications in a regional
distribution compromising the outer
-superior quadrant of the left
breast.
• There is also thickening of the skin
and nipple retraction.
• The imaging findings are highly
suggestive of malignancy: BI-
RADS 5.

23. Ultrasound correlation revealed a spiculated poorly marginated fixed
hypoechoic lesion measuring 2.3x1.7cm in the 10-11 clock position
4.8cm from nipple, 2mm skin deep. The lesion shows marked intra
lesional vascularity.

24. • A 33×28 mm mass with irregular and spiculated margin and type III curve on post contrast kinetic
analysis is noted at the upper central portion of the left breast compatible with BI-RADS assessment
category 5.

25. BIRADS 6
• known biopsy-proven malignancy
• Use after incomplete excision
• Use for monitoring after neo adjuvant chemotherapy
CATAGORY MANAGEMENT
Biopsy proven
malignancy
Surgical excision When
clinically appropriate

26. • Here images of a biopsy proven malignancy.
On the initial mammogram a marker is placed in the
palpable tumor.
Due to the dense fibroglandular tissue the tumor is
not well seen.
Ultrasound demonstrated a 37 mm mass with
indistinct and angular margins and shadowing.
• After chemotherapy the tumor is not visible on the
mammogram.
Ultrasound showed shrinkage of the tumor to a 18
mm mass, which was categorized as BI-RADS 6

27. BREAST DENSITY
• BI-RADS reports also score breast density, which assesses how much fatty, glandular,
and fibrous tissue have in your breasts. Dense breast tissue can make it harder to spot
tumors on mammogram.
• BI-RADS scoring uses four levels of density
• LEVEL 1:Almost all fatty tissue (easiest to see anomalies or tumors)
• LEVEL 2:Scattered areas of dense (fibrous and glandular) tissue, but mostly fatty tissue
• LEVEL 3:Mix of dense and fatty tissue
• LEVEL 4:Mostly dense tissue (hardest to see tumors)

29. LIMITATIONS OF BIRADS
• For younger women, children, and adolescents, the BI-RADS score may not be
reliable.
• It's also important to note that your BI-RADS score doesn't replace the opinion and
insight of healthcare provider or radiologist regarding imaging tests. The number is
not a substitute for a clinical exam.

30. THANK YOU