What is BIRADS in Mammography?

Mammograms may reveal findings such as masses, structural deterioration, microcalcifications, or asymmetry. Because these findings can be detected in both benign tumors and cancers, they should be evaluated by a radiologist experienced in breast radiology.

Radiologists classify breast condition using numerical data to ensure they can accurately and clearly convey their findings and recommendations to other colleagues and to facilitate their own follow-up. Breast imaging reports use a classification system called BIRADS (Breast Imaging Reporting and Data System).

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 by biopsy
If your report states:

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

If BIRADS Categories 1 and 2 are listed, your report indicates that nothing is wrong; you should continue 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.

If your report lists BIRADS Category 3, there's a greater than 95% chance of developing a problem, meaning there's nothing to worry about. However, even if it's less than 5%, there's still a small risk, so 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.

If BIRADS Category 4 is listed, the situation is more critical, with an average risk of cancer of approximately 30-40%. An appropriate biopsy (sampling) should be performed, and if necessary, a breast MRI (magnetic resonance imaging) scan should be performed before the biopsy.

This is an invasive procedure, meaning that if you're unsure, 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 a biopsy has been recommended. The general reason for this may be lack of experience and fear of missing something.

Sometimes, we see unnecessary biopsy recommendations for an image, such as a previous surgery scar, due to miscommunication between the radiologist and surgeon. To avoid unnecessary biopsies, you should ensure that the center where you receive your follow-up care has the necessary equipment, the ability to store your information digitally and access it immediately during your follow-up appointments, 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. MRIs can guide the evaluation of certain lesions, including those in the armpit, that may not be detected by mammography or ultrasound. Scientific studies have shown that a preoperative MRI can alter the surgical treatment plan for a patient in approximately 20% of cases.

I also examined this topic in my specialist thesis submitted in 2006. However, because signals may arise after a biopsy that could lead to misinterpretations, a breast MRI examination is recommended for BIRADS Category 5 lesions before biopsy. Experienced surgeons working in centers specializing in breast cancer always want to have an MRI of the patient they are operating on to ensure there are no unforeseen foci. However, some surgeons are reluctant to waste time with an MRI. They argue that this is because, in many centers, the quality of the MRIs or the experience of the interpreting radiologist are insufficient, and these MRIs can unnecessarily highlight suspicious foci, potentially prolonging 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, undetected by other methods, can be treated during the same session.

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