The BI-RADS Mammography Reporting System
The Breast Imaging Reporting And Data System (BI-RADS) is the standardized reporting system for mammography that indicates how suspicious a particular finding might be.
The BI-RADS system reports mammogram findings using seven standardized categories, or levels. Each BI- RADS category has a follow-up recommendation associated with it to help radiologists and other physicians appropriately manage a patient's care. The categories are:
- Category 0: Assessment is incomplete —Additional imaging and/or prior images are needed before a final assessment can be assigned.
- Category 1: Negative—Continue with routine annual screening.
- Category 2: Benign Finding(s)—Continue with routine annual screening.
- Category 3: Probably Benign Finding— Short-term follow up (usually six months) recommended.
- Category 4: Suspicious Abnormality—Biopsy usually recommended.
- Category 5: Highly Suggestive of Malignancy—Requires a biopsy or surgical treatment.
- Category 6: Known Biopsy-Proven Malignancy—Lesion has already been determined by a biopsy to be cancer.
Breast Density Report
Your report will also describe the composition of your breast tissue. This is divided into four categories related to breast density:
- Category A: Entirely fatty
- Category B: Scattered areas of fibroglandular density
- Category C: Heterogeneously dense, which may obscure masses
- Category D: Extremely dense, which lowers mammography sensitivity
More information about breast density can be found here.
A screening test is, by definition, a test that is done to screen people who are at risk for developing a disease but have no symptoms of it. The goal of screening is to save lives by finding the disease early, before people know that they have it. The Pap test, for example, is a screening test used to identify women who have cells on their cervix that indicate they may be at risk of developing cervical cancer. Similarly, clinical breast exams and mammograms are done routinely on women who have no signs or symptoms of breast cancer to screen for the disease.
Some women who are at high risk of developing breast cancer should have mammography and magnetic resonance imaging (MRI) every year.
A woman is considered to be high risk and and as someone who would benefit from MRI and mammography screening if:
Digital mammography sounds like a major technological advance and an improvement over traditional film mammography. But it is really just another way for the mammographer to read the results of a mammogram. It is similar to the difference between a digital camera and a regular one. The primary advantage is the picture can be saved in a computer, which makes it easier to pass on from one doctor to the next.
Three-dimensional (3D) mammography, also known as digital tomosynthesis, creates images in a similar ways as a computed tomography (CT) scanners, which are used by doctors to get detailed pictures of bone, lung tissue, soft tissue, and blood vessels. Breast tomosynthesis is currently being studied in a number of clinical trials.
I had a bilateral mastectomy with reconstruction. Do I still need to have regular mammograms?
Most women who have had a bilateral mastectomy no longer need to have annual mammograms. Unless the margins were close, positive, or there seems to be a lot of tissue left, most doctors would recommend that a woman have a clinical exam by a medical provider every six months or once a year, depending on the circumstances.