Decoding BIRADS in breast imaging analysis

Updated December 7, 2023

Healthcaretoday, BIRADS, Mammogram, mammogram screening, breast imaging, fibroadenoma, fibrocystic disease, ductal papilloma, breast cysts, breast lesions, Breast Cancer, Cancer,

By Professor Dr See Mee Hoong
Consultant Oncoplastic Breast Surgeon,
UM Specialist Centre

Breast Imaging Reporting and Data System (BIRADS) serves as a crucial framework for categorizing findings from mammogram screenings into distinct classifications. Within this system, over 50 benign breast conditions exist, with fibroadenoma being the most prevalent among younger individuals and fibrocystic disease among older age groups. Other benign conditions encompass ductal papilloma and breast cysts. It's essential to note that not all cases necessitate a biopsy despite regular follow-ups being standard procedure.

There are instances where continual monitoring becomes pivotal, particularly when a patient presents multiple lesions in one breast, rendering biopsy unfeasible. Typically, ultrasounds exhibit clear circumferential details, yet in the absence of risk factors, observation remains the primary approach.

For those without pertinent risk factors, an ultrasound every six months ensures vigilance for any alterations in growth or composition, unless a familial history of breast cancer in first or second-degree relatives becomes apparent, warranting increased concern when lesions manifest between ages 30 and 40.

BIRADS serves as a critical guidepost within this process, delineating findings into distinct categories. Classifications range from BIRADS 0, indicating inadequacy necessitating further adjunct tests, to BIRADS 1 and 2, signifying benign conditions. Routine screenings suffice for these categories, typically on an annual or biennial basis.

BIRADS 3 requires closer monitoring with biannual checks to assess any changes in growth or composition. However, BIRADS 4 and higher demand biopsy for a conclusive determination of malignancy. BIRADS 5 denotes a significantly elevated probability of malignancy, while BIRADS 6 designates a confirmed cancer diagnosis, prompting subsequent mammogram follow-ups for the patient.

In essence, BIRADS plays a pivotal role in guiding medical professionals in their assessment and management of breast conditions, enabling tailored approaches based on the specific classification of findings from mammogram screenings.