Mammogram 'Birad Category' meaning

[SnowWoman]

I'm 46 with history of fibrocystic/dense breasts. Had lumpectomy and partial masectomy of right breast 20 yrs ago due to cystic lumps (another story we won't go into here). Have had mamms. appox. every 2-5 yrs since. Last one in Aug 01 with no negative report.

Recent mamm. (including rolled views & magnification) showed several areas of concern in the superior & lateral region of the left breast - microcalcifications which dispersed with pressure in "a round, benign configuration" & a "1.5-cm diameter, rounded density" which "does not disperse with directed compression".  

Ultrasound showed a 7.0x6.0x1.1 cm rounded, hypoechoic mass which "does not definitively correspond to the mamm. finding, nor can this be confirmed as a simple cyst" & a 0.7x0.6x1.1 cm hypoechoic mass which also can't be corresponded to the mamm. with no mamm. visible lesion at the same site.

The 1.5 cm density (from mamm.) has been classified as "Birad category 4, suspicious", with an "open biopsy recommended". Since they can't determine if the smaller mass found by ultrasound is the same, they suggest a follow up ultrasound & if the lesion is still present, an additional ultra-sound guided biopsy.

I'm amazed that neither I nor my Dr. found any of this especially the large mass. Have meeting scheduled with surgeon in 2 weeks & will go from there.

Can you explain the "Birad Category" ratings?  Short of the biopsy, I realize there is no way to know for sure about cancer but the Dr's. response does not seem optimistic. Is there anything else you can explain about all this?

[CCF-RN,MSN-JS]

Dear SnowWoman, BI-RADS (Breast Imaging-Reporting and Data System) is a scale used by radiologists to standardize the readings of mammograms.  The mammogram is classified according to 5 categories.  Category 1 being negative - nothing to comment on, routine screening.  To 5 which is highly suggestive of malignancy - very high probablility of malignancy.  Appropriate action should be taken.  A category 4 is a suspicious looking abnormality, not characteristic but has a reasonable probability of malignancy.  Biopsy should be considered.

[surgeon]

BIRADS stands for breast imaging reporting data system. It is an attempt to standardize the reading and reporting of mammograms. There still is subjectivity, because each film is read by a human being, who must look at various features and decide what they may or may not mean. As to not feeling a 1.5 cm mass: that's about a half-inch. That's not really very big, and, especially if deep in a dense breast it's not unusual to be un-feelable. If every mass in a breast could be felt, there'd be no reason for mammography. Until you actually get a biopsy, I'd try (easier said that done) not to be too alarmed. When a thing shows on one modality and not another, it's less likely to be significant. And radiologists will error on the side of being alarmist in order to be sure that things are followed up properly. The odds are with you; but certainly it needs a definite diagnosis.

[SnowWoman]

Took some searching but finally found the definition of the BIRAD categories. For others who are interested they are:

BI-RADS O --incomplete assessment
BI-RADS 1 --negative findings (within normal)
BI-RADS 2 --benign findings
BI-RADS 3 --probably benign, 6-month follow-up
BI-RADS 4 --suspicious abnormality, biopsy recommended
BI-RADS 5 --highly suggestive of malignancy

It helps to know where my diagnosis falls along this scale.

[river view]

Thank you so much for posting the Birad Scale.  I've had two biopsies they think didn't get the right sample and probably must decide about a third.  My birad assessment is a 4 so I guess I should go ahead.  My doctor just said I was in the middle but this scale clarifies it better.

[SnowWoman]

There have been several comments lately where biopsies were done but the area of concern was missed. This is somewhat disconcerting and must be verrrry frustrating for you.  I have another 3 months to wait for my follow-up mammo and even though something (fibroadenoma) did show up in my biopsy there is still a nagging concern that the pre-surgery mammos/ultrasound showed more than one finding.  Trying to stay positive and not get bogged down in this.  

Have they explained what has been the issue/problem in doing your biopsies?  Have you gone for a second opinion or consultation with another surgeon?  Do they have a plan for getting it "right" the next time?  Wishing you the best, Janet.

[giggleme]

A related discussion, Was a three now a two was started.

[DABLOO]

A related discussion, axillary lymph nodes & BIRADS category was started.