Breast Imaging Reporting and Database System (BI-RADS)

What is a Bi-rads score?

What is BIRADS (Breast Imaging Reporting and Database System)?

BIRADS or BI-RADS score stands for the Breast Imaging Reporting and Database System score. It’s a scoring system developed by The American College of Radiology (ACR). It was designed for radiologists to describe mammogram findings into a small number of well-defined categories. It has seven categories ranging from Bi rads 0 to Bi-rads 6. Bi-rad 4 is further subdivided into three categories.

How does BIRADS benefit radiologists?

What are the benefits of the BIRADS classification system?

Benefits of the BIRADS Classification System:

  • (1) BI RADS classification standardizes the words used in mammographic reporting.
  • (2) BI-RADS system is very useful in monitoring breast cancer treatment.
  • (3) It is very helpful in supporting breast cancer research.
  • (4) BIRADS improves communication between radiologists, patients and doctors.
  • (5) BI-RADS reduce the confusion among patients and radiologists.
  • (6) BI-RADS classify breast density into four groups which helps radiologists in understanding the mammograms.
  • (7) Radiologists assign each casea category which makes it possible to calculate accuracy statistics that are important in quality assurance.
  • (8) For radiologists whose accuracy statistics are notvery good, this system tells them to get more training. The benefit of BI-RADS to radiologists is that it forces them to think about which category their findings will fit into.

What is meant by breast density?

BI-RADS and breast density:

BI-RADS system classifies breast density into 4 categories. Dense breasts have greater risks of developing breast cancer as they have less fatty tissue. Less dense breasts have more fatty tissue.

The four categories of breast density are:

Mostly fatty breasts:

Breasts have little fibrous and glandular tissue. The breasts are almost entirely fatty. A mammogram of breasts with a lower density can more easily show abnormal findings.

Scattered density breasts:

Scattered density breasts have a lot of fat with few areas of glandular and fibrous tissue (together known as fibroglandular density).

Consistent density breasts:

The distribution of fibrous and glandular tissue is even in such breasts. So it becomes too difficult to detect small abnormalities. It is hard to see small masses in the breast tissue on a mammogram.

Extremely dense breasts:

Such breasts have mostly fibrous and glandular tissues. The breasts are heterogeneously dense. In this condition, it is hard to see tumors in the breast tissue on a mammogram. It becomes tough to differentiate between abnormalities and normal breast tissue. Such condition makes it difficult to detect cancer.

Many states in the U.S. have enacted laws requiring mammography providers to tell women if they have dense breasts and to inform them of the risks associated with having dense breasts.

How many levels are there in BI-RADS assessment system?

The BI-RADS Mammographic Assessment System Scores/Levels:

  1. Category Bi-RADS 0: Incomplete (Need additional imaging evaluation)
  2. Category Bi-RADS 1: Negative
  3. Category Bi-RADS 2: Benign (noncancerous) findings
  4. Category Bi-RADS 3: Probably benign
  5. Category Bi-RADS 4: Suspicious abnormality
  6. Category Bi-RADS 5: Highly suspicious of malignancy (cancer)
  7. Category Bi-RADS 6: Known biopsy with proven malignancy (cancer)

How does the BI-RADS scoring system work?

Doctors use this system to place abnormal findings into categories ranging from 0 to 6. Up to 9% of breast cancer screening mammograms receive a BI-RADS category of 3, 4 or 5. A lot of women over 40 are given BIRADS categories 1 and 2, indicating normal results or that abnormal results are benign, or noncancerous. If you are given a score of 3 or above, doctors and radiologists recommend a follow-up visit or a biopsy.

A follow-up or diagnostic mammography is often recommended if the BI-RADS category is 3 or higher. BIRADS 3 is rarely used nowadays because BIRADS 4 and 5 are categories that lead to biopsies.

Mostly, the radiologists classify breast cancer screening mammograms as either BI-RADS 1 or BI-RADS 2. 

What percentage of mammograms is abnormal?

Chances of being diagnosed with cancer after a callback are small. Of all women who receive regular mammograms, about 10% will get called back for further testing.  About 0.5% of those will be found to have cancer.

Describe BI-RADS Mammographic assessment categories in detail?

The BI-RADS Mammographic assessment categories:

What does Category 0 mean on a mammogram?

What is a Birad 0? What do you mean by a Birds score of 0?

BI-RADS 0 Category Score:

  • BI-RADS Category 0 means that there is not enough information.
  • A score of 0 indicates an incomplete test.
  • The images may be difficult to interpret and understand.
  • BI-RADS Category 0 means the Assessment is not complete
  • The doctor may recommend spot compression, magnification, or breast ultrasound.
  • Doctors may compare new images with older ones to determine if there’ve been any changes in breasts.
  • A BI-RADS score of 0 requires additional tests and images to provide a final assessment.
  • When the ultrasound result shows a benign cyst, then the ultrasound result “completes the BIRADS” and assigns a category 2 to the case because a cyst is benign.

What is a Birad 1? What do you mean by a Birads score 1?

What does Category 1 mean on a mammogram?

BI RADS 1 Category Score:

  • BI-RADS score of 1 confirms that your mammogram results are negative.
  • Bi rads1 tells that there’s no cancer and breasts are of equal density.
  • Your doctor may continue routine screenings.
  • BI RADS category 1 score shows no grouped or suspicious microcalcifications, asymmetrical glandular structure, no well-formed mass, and/or no change from any previous exam.

What does Category 2 mean on a mammogram?

What is a Birad 2? What do you mean by a Birads score 2?

BI RADS 2 Category Score:

  • Birads Category 2 score implies that mammogram results are normal.
  • BI RADS 2 score means the radiologist saw something that is not cancer.
  • There is something abnormal on mammograms but it is not breast cancer.
  • The doctor noticed some benign cysts or masses that are not malignant in any way.
  • There are no indications of breast cancer.
  • Category 2 needs routine visits.

BI-RADS 2 category findings often include:

  1. Round opacities corresponding to a typical cyst at ultrasonography
  2. Scattered macrocalcifications
  3. Oval opacities with a radiolucent center
  4. Typical calcified fibroadenoma or cyst
  5. Fatty densities or partially fatty images
  6. Surgical scar
  7. Lipoma, galactocele, oil cyst, hamartoma
  8. Breast implants, silicone granuloma.
  9. Specs are benign microcalcifications
  10. Calcium buildup is in layers
  11. Benign microcalcification
  12. Round opacities with macrocalcifications
  13. Vascular calcifications

What do you mean by a Birads score of 3? What is a Birad 3?

What does Category 3 mean on a mammogram?

BI RADS 3 Category Score:

  • Bi-rad 3 Category score means that mammogram results are probably normal.
  • There’s a 2 percent chance of cancer.
  • BI-RADS 3 is a challenging assessment category.
  • Your radiologist will recommend a follow-up visit within 6 months to prove the findings are benign.
  • BI-RADS 3 is probably benign.
  • In this case, doctors recommend a follow-up visit within six months
  • No palpable lesion is present.
  • You’ll need to have regular visits

Can BI RADS 3 be cancer?

A BIRADS score of 3 means that your mammogram is probably normal but there is a 2% chance of cancer.

Is Birads 3 dangerous?

BI-RADS 3 lesions are common on screening ultrasound. This category causes great anxiety for patients due to unnecessary biopsies and additional imaging. As this costs too much to have additional imaging tests, so it leads to anxiety. According to a research, the malignancy rate in BI-RADS 3 lesions was 0.8%.

Findings of BI RADS Category 3 are:

  • Round, ovoid, and well defined non-calcified solid nodules
  • Round or oval Clusters of tiny calcifications
  • Miscellaneous focal findings
  • Selected focal asymmetrical areas of fibroglandular densities
  • Generalized distribution in both breasts
  • In some cases, a percutaneous biopsy might be considered even for BIRADS category 3. Such as extreme patient anxiety, plans for breast augmentation, pregnancy plans, reduction surgery, or if synchronous carcinoma is present.
  • These tiny specs are diffused punctate microcalcifications.
  • Round microcalcification with edges not sharply defined. It would be called ‘indeterminate BI-RADS 3 and not BI-RADS 2, because of the poorly defined, fuzzy edges.

What does Category 4 mean on a mammogram?

What do you mean by a Birads category score 4? What is a Birad 4?

BI RADS 4 Category Score:

  • A category 4 Bi-rads score indicates a suspicious finding or Indeterminate abnormality.
  • Breast cancer risk starts to increase here.
  • A lump is present but does not initially appear to have the morphological characteristics of cancer.
  • There is a 20 to 35 percent chance of cancer.
  • To confirm, your breast cancer physician will need to perform a biopsy to test a small tissue sample.
  • BI-RADS category 4 score is split into 3 subcategories based on the doctor’s level of suspicion.


There is low suspicion of cancer or malignant findings. A birads 4a has a 13% chance of malignancy.


In Bi-rads 4b, their ismoderate suspicion for cancer or malignant findings. And for birads 4b, there is a 36% chance of malignancy.


BIRADS 4C has a high suspicion of cancerous or malignant findings. Finally, a birads 4c has a 79% chance of malignancy. BI-RADS category 4C has a high positive predictive value for breast cancer. The positive predictive value of breast cancer increases up to around 79%. About 70% of category 4C breast lesions come out as ductal carcinoma in situ.

Findings of BIRADS category 4 include:

  • Category 4C indicates a high risk for breast cancer.
  • About 20-40% chance of a real cancer
  • Positive predictive value
  • Fibrocystic changes are the most common finding
  • Round or oval noncystic opacities with microlobulated or obscured contours
  • Indeterminate microcalcifications appearing amorphous and indistinct particularly if in a cluster or heterogeneous and pleomorphic
  • Fibroadenoma found in about 19% of cases
  • Powderish microcalcifications in large clusters
  • Localized or evolving asymmetric hyperdensities with convex contours
  • DCIS is confirmed about 23% of the time with columnar cell change

Does Birads 4 mean cancer?

Bi-rads 4 mean 23% to 34% chances of cancer. It also means a 66% to 77% chance of NOT having breast cancer. In category 4 Bi rads, the chances of the breast lesionbeing diagnosed as Ductal Carcinoma in Situ (DCIS) increases. With category 4B lesions DCIS is about 21% of the time, but this drops to 10% of the time with category 4A breast lesions.

What is the difference between Bi Rads category 4 and category 5 Bi-Rads?

A BI-RADS 4 category mammogram has a positive predictive value of about 30 Percent while a category 5 mammogram has a positive predictive value of about 95%. Category 5 Bi-rads are almost certainly predictive of breast cancer. Category 5 is highly suggestive of malignancy.

What is a Birad 5? What does Category 5 mean on a mammogram?

What do you mean by a Birads category score of 5?

BI-RADS 5 Category Score:

In category 5 BI-RADS there’s at least a 95% chance of breast cancer. Your doctor will recommend a biopsy when there is a very high probability of breast cancer. A biopsy determines the next steps for treatment. After biopsy the average rate of carcinoma in category 5 biopsies is about 75-97 percent. Category 5 breast lesions have a 95% chance of malignancy.

Is Birads 5 Always cancer?

Category 5 indicates a high suspicion of cancer. This Bi-rads category has a positive predictive value of breast cancer ranging between about 80% and 97%. Lesions have a 95% probability of malignancy in Birads 5 category. A biopsy is highly recommended to confirm results.

Does Bi-rads 5 category means I’m going to die?

Bi-rads 5 indicate an 80% to 97% chance of cancer. No, definitely you are not going to die. Mostly cancers are cured, in fact over 85%.

Findings typical of category five include:

  • Evolving microcalcifications or associated with an architectural distortion or opacity
  • Poorly circumscribed opacities with ill-defined and irregular contours
  • Typically malignant microcalcifications
  • Linear microcalcifications with branching pattern
  • If numerous, clustered and with a segmental distribution
  • Spiculated opacities with radio-opaque center
  • Branched and granular casting microcalcifications
  • Clusters of microcalcifications with a segmental or galactophorous distribution
  • Casting microcalcifications appear linear, fragmented, and branching

What do you mean by a Birad category score 6?

What does Category 6 mean on a mammogram? What is a Birads 6?

BI RADS 6 Category Score:

  1. BI RADS 6 category indicates a known cancer, proven by biopsy.
  2. This category is used when patients undergoing breast cancer treatment have follow-up mammograms.
  3. Category 6 isn’t useful for accuracy statistics.
  4. Certain microcalcifications might even be ‘directly’ associated with breast cancer

What is the general information about Bi-rads system classification?

  • BI-RADS mammogram classifications are generalizations.
  • They tend to revolve around the presence and type of microcalcifications.
  • It is a means of standardizing communications.
  • BI-RADS mammogram classifications are not intended as a diagnostic tool,
  • BI-RADS mammogram classifications help in identifying situations where follow-up is required.

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