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Breast Imaging

E2228. BI-RADS Category 3: To Follow or Not to Follow, That Is the Question

Gill T1,  Al-Khalisi N1,2,  Saettele M.1,2 1. University of Missouri-Kansas City, Kansas City, MO; 2. Saint Luke's Hospital, Kansas City, MO

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Background Information: BI-RADS aims to standardize reporting and reduce confusion in interpretations of breast imaging. There is strong literature support for the proper use and follow-up of BI-RADS category 3 assessments in both mammography and ultrasound; however, the use of BI-RADS category 3 in MRI is still an area of investigation. Knowledge of the specific imaging findings in which a BI-RADS category 3 assessment may be given and of the appropriate follow-up algorithm will help facilitate better patient care. This exhibit will discuss the literature-supported criteria for assigning a BI-RADS category 3 to mammography and breast ultrasound findings along with corresponding appropriate management recommendations.

Educational Goals/Teaching Points: After completing this exhibit learners should be able to describe the literature supported mammography and ultrasound imaging findings for which a BI-RADS category 3 assessment may be appropriately given. Additional goals include understanding the surveillance algorithm for category 3 assessments, discussing situations when a change in assessment category or biopsy may occur, and finally, there is a self-assessment review examination.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: BI-RADS category 3 implies that an imaging finding is probably benign, which includes findings that have a greater than 0% but less than or equal to 2% likelihood of malignancy. The specific criteria for this category are unique to each modality. For mammography, we will present noncalcified circumscribed solid masses, focal asymmetry, and a solitary group of punctate calcifications. For ultrasound, we will present a solid mass with circumscribed margins, oval shape and parallel orientation, an isolated complicated cyst, and clustered microcysts. We will use case examples to highlight these imaging findings.

Conclusion: BI-RADS category 3, though previously used by many as a wastebasket for indeterminate findings, is a well-defined category in mammography and ultrasound for specific imaging findings. It is important for proper patient care that radiologists appropriately assign a BI-RADS category 3 assessment and follow these findings according to the literature-based criteria set by the BI-RADS manual.