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


Round 60% malignant


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


Irregular 60% malignant



Margins.

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


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

Margins.

Microlobulated



Margins.

Indistinct



Margins.

Angular: 60% malignant



Margins.

Spiculated: 86% malignant



Internal echo pattern.



Hypo echoic•Most common•Compare to fat




Iso echoic•Compare to fat




Hyper echoic•Mostly benign•Compare to fat

Posterior acoustic features.



Enhancement•Indeterminate•SonoCT off

Posterior acoustic features.

Shadow



Benign NPV



84%78%90%

Malignant PPV


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


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









BIRADS 4

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

1st visit BIRADS 3


IDC

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


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

BIRADS 4: posterior border indistinctIDC


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


BI-RADS 4B.

Parallel, hypo echoic, indistinct, mixed echopatternDCIS


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,


Technique

Importance of correlation in location between US and mammography.



Importance of correlation in location between US and mammography.



Clinical

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



Abscess

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


Post traumatic fat necrosis.

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


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


Figure 8c. Confirmation of lesion penetration.



Figure 10a. Appearance of the specimen in formalin.

Fat


Figure 10b. Appearance of the specimen in formalin.

Tissue


BIRADS 5: irregular, spiculated, hypo echoid with shadow


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



BenignMalignant




Other

Type 1 6%

Type 2

Type 3 >30%

t

%

MRI

Elastosonography

Fibroadenoma.

Smaller on Elastosono


Invasive ductal carcinoma.

Carcinoma larger on Elastosono


BenignMalignant




Health & Medicine

Birads US 3 - 5