What is BIRADS in Breast Ultrasonography?

After evaluation, radiologists classify breast conditions using a number to ensure they can accurately and clearly communicate their findings and recommendations to other colleagues and to facilitate their own follow-up. A classification called BIRADS (Breast Imaging Reporting and Data System) is used in breast imaging reports.

BIRADS Classification:
Category 0: Additional imaging methods are needed
Category 1: Normal findings
Category 2: Definitely benign findings
Category 3: Probably benign findings
Category 4: Suspicious findings
Category 5: Highly likely malignant findings
Category 6: Patients with breast cancer detected through biopsy
If your report states:

BIRADS Category 0, the radiologist performing the examination has reached a decision and is requesting additional testing.

If BIRADS Category 1 or BIRADS Category 2 are listed in your report, it means there is nothing wrong and that it is sufficient to attend your annual checkups regularly, just like any other normal woman. BIRADS Category 1 means completely normal, while BIRADS Category 2 means some findings are present, but all are benign lesions.

A BIRADS Category 3 report indicates a greater than 95% probability of no concern. However, there is a small risk, even if less than 5%, and your radiologist will want to re-examine you in six months. Don't skip this checkup; I strongly recommend seeing the same radiologist every six months for two years, if possible.

A BIRADS Category 4 report indicates a more critical situation, with an average risk of cancer at approximately 30-40%. A biopsy (sampling) should be performed appropriately, and if necessary, a breast MRI (magnetic resonance imaging) should be performed before the biopsy. Since this is an invasive procedure, if you're unsure about the procedure, you can consult a radiologist experienced in breast radiology before the biopsy to obtain a second opinion.

I emphasize this because we see many patients who come to our clinic seeking a second opinion, even though they've been offered a biopsy, that they are being offered an unnecessary biopsy. This is generally due to a lack of experience and a fear of missing something. Sometimes, we see a biopsy being offered unnecessarily based on an image, such as a previous surgery scar, due to a lack of communication between the radiologist and surgeon.

To avoid unnecessary biopsies, you should ensure that the center where you receive your follow-up care has adequate equipment, that your information is stored digitally and readily accessible during follow-up visits, and, most importantly, that the radiologist you visit is experienced in breast radiology.

BIRADS Category 5 means there's a greater than 90% chance you have cancer. You should have an MRI of both breasts immediately, followed by a biopsy without delay. MRI scans are helpful in evaluating the axillary region and some lesions not detected by mammography and ultrasonography. Scientific studies have shown that a preoperative MRI scan alters the surgical treatment plan for nearly 20% of patients.

I also explored this topic in my specialist thesis submitted in 2006. However, because signals can sometimes be misleading after a biopsy, a breast MRI scan is recommended for BIRADS Category 5 lesions before a biopsy. Experienced surgeons working in centers specializing in breast surgery always want to have an MRI scan performed on the patient they are operating on to ensure there are no unforeseen lesions.

However, some surgeons are reluctant to waste time with MRI scans. They argue that this is because, in many centers, the quality of the MRIs or the experience of the interpreting radiologist may be insufficient, leading to unnecessary delays in the treatment process. However, it's important to remember that the best course of action is to have a high-quality breast MRI performed before surgery and have it evaluated by an experienced breast radiologist.

This significantly prevents early cancer recurrences, and there's a 5% chance that another tumor that might not have been detected by other methods can be treated during the same session.

BIRADS Category 6 is a classification used for patients diagnosed with malignancy.