7.3: BI-RADS

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The Breast Imaging – Reporting and Data System

This ACR established schema is in its fifth edition. It has been established and deployed in an attempt to standardize the information included in a breast imaging report and to provide a methodology for reviewing outcomes based upon standardized descriptors of imaging findings and standardized management strategies. The data from this schema can be used to evaluate positive and negative biopsy results and improve the quality of patient care.

After detecting and describing the abnormal findings present on the imaging examination the final breast imaging report (mammography, ultrasound, magnetic resonance imaging) will include an assessment that reflects the findings of the examination, provides a management recommendation, and is associated with an estimate of the potential risk of malignancy.

Table 1: BiRads Classification with Suggested Management and Likelihood of Breast Cancer (adapted)
Category	Management	Likelihood of Cancer
0 – Incomplete Imaging Assessment	Recall or arrange to complete the imaging assessment	Unknown
1 – Negative	Continue Screening	No > General population
2 – Benign Findings	Continue Screening	No > General population
3 – Probably Benign Findings	Short-term imaging follow-up (6 months)	< 2% Likelihood
4 – Suspicious	Tissue diagnosis	> 2% – 95% Likelihood Subtypes 4A, 4B, 4C with progressively greater likelihoods of malignancy
5 – Malignancy Very Likely	Tissue diagnosis	> 95% Likelihood
6 – Known, biopsy proven, malignancy	Treatment of Malignancy	100%