Question

Ultrasound BI-RADS.

Hint:

In ultrasound BI-RADS, BI-RADS 3 suggests a probably benign lesion, and BI-RADS 4 is suspicious for malignancy, indicating the need for biopsy.

Answer 1

Step 1: Introduction to Ultrasound BI-RADS.
The Breast Imaging Reporting and Data System (BI-RADS) is a system developed by the American College of Radiology (ACR) for categorizing breast imaging findings, primarily in mammography and breast ultrasound. It helps standardize the interpretation of breast imaging studies and provides a way to communicate findings clearly and consistently. BI-RADS is used to assess the risk of malignancy and guide further management decisions. Ultrasound BI-RADS is an extension of the BI-RADS system applied specifically to breast ultrasound. It categorizes findings based on features such as shape, margins, echo pattern, and vascularity. The system helps radiologists evaluate the likelihood of a lesion being benign or malignant and provides a framework for follow-up recommendations.
Step 2: Ultrasound BI-RADS Categories.
(1) BI-RADS 1: Negative - Description: No abnormalities are detected on the ultrasound. The breast tissue is normal with no lesions. - Management: Routine screening is advised based on age and risk factors. (2) BI-RADS 2: Benign - Description: The lesion is benign with no suspicious features. Common benign findings include simple cysts, fibroadenomas, or adenomas. - Management: Routine follow-up or screening is typically recommended. (3) BI-RADS 3: Probably Benign - Description: The lesion is likely benign, but further evaluation is recommended for reassurance. Features may include oval shape, smooth margins, and homogeneous echo texture. Lesions such as simple cysts and benign fibroadenomas are examples. - Management: Short-term follow-up imaging (usually 6 months) is recommended to monitor for any changes in the lesion's characteristics. (4) BI-RADS 4: Suspicious Abnormality - Description: The lesion has characteristics that are suspicious for malignancy, such as irregular shape, microcalcifications, or ill-defined borders. - Management: Biopsy is recommended to confirm the diagnosis and rule out malignancy. - BI-RADS 4A: Low suspicion of malignancy (5-10% probability). - BI-RADS 4B: Moderate suspicion of malignancy (10-50% probability). - BI-RADS 4C: High suspicion of malignancy (50-95% probability). (5) BI-RADS 5: Highly Suggestive of Malignancy - Description: The lesion has features highly suggestive of malignancy, such as irregular shape, spiculated margins, and hypoechoic appearance. - Management: Biopsy is essential, and surgery may be indicated if the lesion is confirmed to be malignant. (6) BI-RADS 6: Known Biopsy-Proven Malignancy - Description: The lesion has been confirmed as malignant by previous biopsy. - Management: Treatment, such as surgery, chemotherapy, or radiation, is indicated based on the pathology results.
Step 3: Key Features Considered in Ultrasound BI-RADS.
- Shape: Oval (benign) vs. irregular (malignant). - Margins: Smooth (benign) vs. irregular or spiculated (malignant). - Echo pattern: Homogeneous (benign) vs. heterogeneous (malignant). - Vascularity: Low or absent vascularity (benign) vs. increased vascularity (malignant).