A Pictorial Review of Changes in the BI-RADS Fifth Edition

Abstract

Initially developed in 1993, the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) lexicon serves to standardize breast imaging reports, improve communication with referring physicians, and provide a quality assurance tool. The long-awaited BI-RADS fifth edition consolidates, improves, and expands the lexicon for mammography, breast ultrasonography (US), and breast magnetic resonance (MR) imaging. The new edition has increased the number of imaging examples to nearly 600. The breast MR imaging lexicon is significantly expanded since it first appeared in the fourth edition. New terms have been added to the US lexicon to reflect technologic advances. Minor but important changes have been made to the mammography section. Calcification descriptors in the lexicon are now consolidated into two categories: benign and suspicious. The controversial "intermediate concern" grouping has been eliminated, and a table in the lexicon summarizes the literature supporting the recommendation to biopsy such calcifications. New descriptors such as "developing asymmetry" are illustrated, and abstracts are provided to reference their significance. A generous guidance section is included after the lexicon description for each modality. Useful frequently asked questions are succinctly answered, and the literature to support each answer is included in the reference section for each modality. This review article illustrates and highlights changes to the BI-RADS lexicon and provides readers with a general overview to familiarize them with the fifth edition. (©)RSNA, 2016.

Weakly supervised 3D deep learning for breast cancer classification and localization of the lesions in MR images

“…For breast cancer, MRI BI‐RADS is used to characterize breast lesions based on the shape, margin, internal enhancement characteristics, as well as nonmass enhancement, with some certain descriptors indicating malignancy, e.g., an irregular mass margin, the segmental distribution, the clustered ring, etc. Clinically, radiologists grade the BI‐RADS categories into six levels, from level‐1 to level‐6, indicating that the patient is negative, benign, probably benign, suspicious, highly suggestive of malignancy, and biopsy‐proven malignancy, respectively . However, the BI‐RADS category assessment suffers from the limitation of interobserver variance and often subjectively relies on the radiologist's experience…”

“…3 Particularly, dynamic contrastenhanced (DCE) MRI can provide accurate information on the location, size, and volume of the lesions, and has become the first-line method for assessment of tumors. 4,5 The MRI lexicon in the Breast Imaging-Reporting and Data System (BI-RADS) atlas 6 provides a standardized language that allows radiologists to communicate significant findings. For breast cancer, MRI BI-RADS is used to characterize breast lesions based on the shape, margin, internal enhancement characteristics, as well as nonmass enhancement, with some certain descriptors indicating malignancy, e.g., an irregular mass margin, the segmental distribution, the clustered ring, etc.…”

“…Clinically, radiologists grade the BI-RADS categories into six levels, from level-1 to level-6, indicating that the patient is negative, benign, probably benign, suspicious, highly suggestive of malignancy, and biopsy-proven malignancy, respectively. 6 However, the BI-RADS category assessment suffers from the limitation of interobserver variance and often subjectively relies on the radiologist's experience. 7 Automatic methods can help to reduce the interobserver variance and improve reproducibility.…”

Correlation between ultrasonographic features and histopathological findings of breast lesions in biopsies

“…The identification of lesions suspected of malignancy determines the need of cytological or histopathological evaluation through a minimally invasive procedure, whose arsenal consists basically of fine-needle aspiration (FNAB) or core-biopsy; in discordant cases, the open biopsy is used to determine the definitive diagnosis of the lesion [1][2][3] . Current data point to reliability of the BIRADS ® classification for the professional in making decisions regarding the conduct of breast lesions, based on the possibility of a particular lesion being benign or malignant, and in analyzing its imaging features in order to treat each patient properly and in time.…”

Breast cystic lesions: Not so simple after all? An ultrasonographic tactical approach

“…At ultrasound, depending on the intricacy of structural alterations, cystic breast lesions are assorted as either simple, complicated or complex, according to the Breast Imaging Reporting and Data System of the American College of Radiology (ACR BI-RADS® lexicon) [6].…”