Birads US 3 - 5

Birads 3-5 Ultrasound

BIRADS

• 3 - Probably benign: 6,12,(18),24 month

• 4 - Biopsy (A,B,C) 2-95% risk• 5 - Cancer (>95%)

BenignMalignant

•Oval•Parallel to skin•Circumscribed

•Sharp boundary•Hyper echoic

•Irregular / round•Not parallel•Indistinct, angular, spiculated•Echogenic halo•Mixed echopattern•Posterior shadow

Orientation and shape.

Oval 16% malignant

©2010 by Radiological Society of North America

Benign•Oval•Parallel to skin•Circumscribed•Sharp boundary•Hyper echoic

Orientation and shape.

Round 60% malignant

©2010 by Radiological Society of North America

Malignant•Irregular / round•Not parallel•Indistinct, angular, spiculated•Halo•Mixed pattern•Shadow

Orientation and shape.

Irregular 60% malignant

©2010 by Radiological Society of North America

Malignant•Irregular / round•Not parallel•Indistinct, angular, spiculated•Halo•Mixed pattern•Shadow

Margins.

Raza S et al. Radiographics 2010;30:1199-1213

©2010 by Radiological Society of North America

Benign•Oval•Parallel to skin•Circumscribed•Sharp boundary•Hyper echoic

Margins.

Microlobulated

©2010 by Radiological Society of North America

Malignant•Irregular / round•Not parallel•Indistinct, angular, spiculated•Halo•Mixed pattern•Shadow

Margins.

Indistinct

©2010 by Radiological Society of North America

Malignant•Irregular / round•Not parallel•Indistinct, angular, spiculated•Halo•Mixed pattern•Shadow

Margins.

Angular: 60% malignant

©2010 by Radiological Society of North America

Malignant•Irregular / round•Not parallel•Indistinct, angular, spiculated•Halo•Mixed pattern•Shadow

Margins.

Spiculated: 86% malignant

©2010 by Radiological Society of North America

Malignant•Irregular / round•Not parallel•Indistinct, angular, spiculated•Halo•Mixed pattern•Shadow

Internal echo pattern.

Raza S et al. Radiographics 2010;30:1199-1213

©2010 by Radiological Society of North America

Hypo echoic•Most common•Compare to fat

Internal echo pattern.

Raza S et al. Radiographics 2010;30:1199-1213

©2010 by Radiological Society of North America

Iso echoic•Compare to fat

Internal echo pattern.

Raza S et al. Radiographics 2010;30:1199-1213

©2010 by Radiological Society of North America

Hyper echoic•Mostly benign•Compare to fat

Posterior acoustic features.

Raza S et al. Radiographics 2010;30:1199-1213

©2010 by Radiological Society of North America

Enhancement•Indeterminate•SonoCT off

Posterior acoustic features.

Shadow

©2010 by Radiological Society of North America

Malignant•Irregular / round•Not parallel•Indistinct, angular, spiculated•Halo•Mixed pattern•Shadow

Benign NPV

•Oval•Parallel to skin•Circumscribed

•Sharp boundary•Hyper echoic

84%78%90%

Malignant PPV

•Irregular / round•Not parallel•Indistinct, angular, spiculated•Echogenic halo•Mixed echopattern•Posterior shadow

62%69%

86%

BIRADS 3

“Lobulated mass, BI-RADS 3,” in a 40-year-old woman with a circumscribed left breast mass seen at mammography.

Oval, sharp, parallel, hypoFibro adenoma

©2010 by Radiological Society of North America

Hematoma in a 45-year-old woman with recent trauma to her right breast.

Raza S et al. Radiographics 2010;30:1199-1213

©2010 by Radiological Society of North America

Hematoma in a 45-year-old woman with recent trauma to her right breast.

Raza S et al. Radiographics 2010;30:1199-1213

©2010 by Radiological Society of North America

Hematoma in a 45-year-old woman with recent trauma to her right breast.

Raza S et al. Radiographics 2010;30:1199-1213

©2010 by Radiological Society of North America

BIRADS 4

Palpable mass in the left breast of a 70-year-old woman.

1st visit BIRADS 3

©2010 by Radiological Society of North America

IDC

2nd visit BIRADS 4: circumscribed, hypo, not parallel

©2010 by Radiological Society of North America

US image of a 50-year-old woman who presented with a palpable mass (arrows) in the right breast.

BIRADS 4: posterior border indistinctIDC

©2010 by Radiological Society of North America

BI-RADS 4A in a 55-year-old woman who presented with a palpable mass and swelling in her left breast.

Oval, hypo echoic, partial indistinct, posterior enhancement.Surgery: ruptured cyst

©2010 by Radiological Society of North America

BI-RADS 4B.

Parallel, hypo echoic, indistinct, mixed echopatternDCIS

©2010 by Radiological Society of North America

BIRADS 5

BI-RADS 5 in a 59-year-old woman with an irregular spiculated mass seen at mammography.

Indistinct, hypo, irregular / spiculated, not parallel, shadow,

©2010 by Radiological Society of North America

Technique

Importance of correlation in location between US and mammography.

Raza S et al. Radiographics 2010;30:1199-1213

©2010 by Radiological Society of North America

Importance of correlation in location between US and mammography.

Raza S et al. Radiographics 2010;30:1199-1213

©2010 by Radiological Society of North America

Clinical

27-year-old woman with a palpable right subareolar mass that was extremely tender to palpation, who also reported 2 days of fever.

Raza S et al. Radiographics 2010;30:1199-1213

©2010 by Radiological Society of North America

Abscess

BIRADS 4a:oval, partly indistinct border, complex echopattern, parallelAspirate

©2010 by Radiological Society of North America

Post traumatic fat necrosis.

BIRADS 3: oval, circumscribed, mixed, parallel, at trauma site

©2010 by Radiological Society of North America

Negative biopsy

• Technique• Correlation Histology / Radiology

– Repeat biopsy– Follow up 6m / 12m

Figure 8b.  Confirmation of lesion penetration.

Youk J H et al. Radiographics 2007;27:79-94

©2007 by Radiological Society of North America

Figure 8c.  Confirmation of lesion penetration.

Youk J H et al. Radiographics 2007;27:79-94

©2007 by Radiological Society of North America

Figure 10a.  Appearance of the specimen in formalin.

Fat

©2007 by Radiological Society of North America

Figure 10b.  Appearance of the specimen in formalin.

Tissue

©2007 by Radiological Society of North America

BIRADS 5: irregular, spiculated, hypo echoid with shadow

©2007 by Radiological Society of North America

Figure 13b.  Radiologic-histologic discordance in a 41-year-old woman with invasive ductal carcinoma.

Youk J H et al. Radiographics 2007;27:79-94

©2007 by Radiological Society of North America

BenignMalignant

•Oval•Parallel to skin•Circumscribed

•Sharp boundary•Hyper echoic

•Irregular / round•Not parallel•Indistinct, angular, spiculated•Echogenic halo•Mixed echopattern•Posterior shadow

Other

Type 1 6%

Type 2

Type 3 >30%

t

%

MRI

Elastosonography

Fibroadenoma.

Smaller on Elastosono

©2009 by Radiological Society of North America

Invasive ductal carcinoma.

Carcinoma larger on Elastosono

©2009 by Radiological Society of North America

BenignMalignant

•Oval•Parallel to skin•Circumscribed

•Sharp boundary•Hyper echoic

•Irregular / round•Not parallel•Indistinct, angular, spiculated•Echogenic halo•Mixed echopattern•Posterior shadow