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Ultrasound BI-RADS Lexicon and Usage
Wendie A. Berg, MD, PhD, FACR, FSBI
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KEY FACTS

  • Terminology

    • Imaging

      • Diagnostic Checklist

        TERMINOLOGY

        • Abbreviations

          • Breast Imaging Reporting and Data System (BI-RADS) for Ultrasound (US)
            • Terms may undergo revision; consult current edition of lexicon from American College of Radiology (ACR)
            • Minor modifications to phrasing have been made
        • Definitions

          • Lexicon: Standardized terms to describe breast echotexture, breast US lesion features, assessment and management recommendations
            • Facilitates communication across facilities
            • Facilitates tracking of patients and outcomes analysis

        IMAGING

        • Indication for Examination

          • Imaging Protocols and Documentation

            • Background Echotexture

              PATHOLOGY

              • Findings

                • Pathology-Based Imaging Issues

                  DIAGNOSTIC CHECKLIST

                  • Consider

                    • Image Interpretation Pearls

                      • Reporting Tips

                        • Assessments and Recommendations

                          Selected References

                          1. Yoon JH et al: Effect of training on ultrasonography (US) BI-RADS features for radiology residents: a multicenter study comparing performances after training. Eur Radiol. ePub, 2019
                          2. Ha SM et al: Growing BI-RADS category 3 lesions on follow-up breast ultrasound: malignancy rates and worrisome features. Br J Radiol. 91(1087):20170787, 2018
                          3. Koh J et al: Intrinsic Subtypes of Breast Cancers Initially Assessed as Probably Benign or of Low Suspicion on Ultrasonography Differ According to Tumor Size. J Ultrasound Med. 37(6):1503-1509, 2018
                          4. Moon HJ et al: Follow-up interval for probably benign breast lesions on screening ultrasound in women at average risk for breast cancer with dense breasts. Acta Radiol. 59(9):1045-1050, 2018
                          5. Marcon M et al: First ultrasound diagnosis of BI-RADS 3 lesions in young patients: Can 6-months follow-up be sufficient to assess stability? Eur J Radiol. 89:226-233, 2017
                          6. Watanabe T et al: Ultrasound image classification of ductal carcinoma in situ (DCIS) of the breast: Analysis of 705 DCIS lesions. Ultrasound Med Biol. 43(5):918-925, 2017
                          7. Lee J et al: Non-mass lesions on screening breast ultrasound. Med Ultrason. 18(4):446-451, 2016
                          8. Elverici E et al: Nonpalpable BI-RADS 4 breast lesions: sonographic findings and pathology correlation. Diagn Interv Radiol. 21(3):189-94, 2015
                          9. Mendelson EB et al: Breast Imaging Reporting and Data System: BI-RADS, Ultrasound. 2nd ed. Reston: American College of Radiology, 2013
                          10. Lehman CD et al: Accuracy and value of breast ultrasound for primary imaging evaluation of symptomatic women 30-39 years of age. AJR Am J Roentgenol. 199(5):1169-77, 2012
                          11. Linda A et al: Hyperechoic lesions of the breast: not always benign. AJR Am J Roentgenol. 196(5):1219-24, 2011
                          12. Berg WA et al: Cystic breast masses and the ACRIN 6666 experience. Radiol Clin North Am. 48(5):931-87, 2010
                          13. Loving VA et al: Targeted ultrasound in women younger than 30 years with focal breast signs or symptoms: outcomes analyses and management implications. AJR Am J Roentgenol. 195(6):1472-7, 2010
                          14. Raza S et al: US of breast masses categorized as BI-RADS 3, 4, and 5: pictorial review of factors influencing clinical management. Radiographics. 30(5):1199-213, 2010
                          15. Kim EK et al: Clinical application of the BI-RADS final assessment to breast sonography in conjunction with mammography. AJR Am J Roentgenol. 190(5):1209-15, 2008
                          16. Berg WA et al: Breast US: Cystic and probably benign breast lesions. Feig SA et al. Categorical Course Syllabus: Breast Imaging. Oak Brook: RSNA. 115-24, 2005
                          17. Hong AS et al: BI-RADS for sonography: positive and negative predictive values of sonographic features. AJR Am J Roentgenol. 184(4):1260-5, 2005
                          18. Graf O et al: Follow-up of palpable circumscribed noncalcified solid breast masses at mammography and US: can biopsy be averted? Radiology. 233(3):850-6, 2004
                          19. Gordon PB et al: Solid breast masses diagnosed as fibroadenoma at fine-needle aspiration biopsy: acceptable rates of growth at long-term follow-up. Radiology. 229(1):233-8, 2003
                          20. Stavros AT et al: Solid breast nodules: use of sonography to distinguish between benign and malignant lesions. Radiology. 196(1):123-34, 1995
                          Related Anatomy
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                          Related Differential Diagnoses
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                          References
                          Tables

                          Tables

                          KEY FACTS

                          • Terminology

                            • Imaging

                              • Diagnostic Checklist

                                TERMINOLOGY

                                • Abbreviations

                                  • Breast Imaging Reporting and Data System (BI-RADS) for Ultrasound (US)
                                    • Terms may undergo revision; consult current edition of lexicon from American College of Radiology (ACR)
                                    • Minor modifications to phrasing have been made
                                • Definitions

                                  • Lexicon: Standardized terms to describe breast echotexture, breast US lesion features, assessment and management recommendations
                                    • Facilitates communication across facilities
                                    • Facilitates tracking of patients and outcomes analysis

                                IMAGING

                                • Indication for Examination

                                  • Imaging Protocols and Documentation

                                    • Background Echotexture

                                      PATHOLOGY

                                      • Findings

                                        • Pathology-Based Imaging Issues

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              • Reporting Tips

                                                • Assessments and Recommendations

                                                  Selected References

                                                  1. Yoon JH et al: Effect of training on ultrasonography (US) BI-RADS features for radiology residents: a multicenter study comparing performances after training. Eur Radiol. ePub, 2019
                                                  2. Ha SM et al: Growing BI-RADS category 3 lesions on follow-up breast ultrasound: malignancy rates and worrisome features. Br J Radiol. 91(1087):20170787, 2018
                                                  3. Koh J et al: Intrinsic Subtypes of Breast Cancers Initially Assessed as Probably Benign or of Low Suspicion on Ultrasonography Differ According to Tumor Size. J Ultrasound Med. 37(6):1503-1509, 2018
                                                  4. Moon HJ et al: Follow-up interval for probably benign breast lesions on screening ultrasound in women at average risk for breast cancer with dense breasts. Acta Radiol. 59(9):1045-1050, 2018
                                                  5. Marcon M et al: First ultrasound diagnosis of BI-RADS 3 lesions in young patients: Can 6-months follow-up be sufficient to assess stability? Eur J Radiol. 89:226-233, 2017
                                                  6. Watanabe T et al: Ultrasound image classification of ductal carcinoma in situ (DCIS) of the breast: Analysis of 705 DCIS lesions. Ultrasound Med Biol. 43(5):918-925, 2017
                                                  7. Lee J et al: Non-mass lesions on screening breast ultrasound. Med Ultrason. 18(4):446-451, 2016
                                                  8. Elverici E et al: Nonpalpable BI-RADS 4 breast lesions: sonographic findings and pathology correlation. Diagn Interv Radiol. 21(3):189-94, 2015
                                                  9. Mendelson EB et al: Breast Imaging Reporting and Data System: BI-RADS, Ultrasound. 2nd ed. Reston: American College of Radiology, 2013
                                                  10. Lehman CD et al: Accuracy and value of breast ultrasound for primary imaging evaluation of symptomatic women 30-39 years of age. AJR Am J Roentgenol. 199(5):1169-77, 2012
                                                  11. Linda A et al: Hyperechoic lesions of the breast: not always benign. AJR Am J Roentgenol. 196(5):1219-24, 2011
                                                  12. Berg WA et al: Cystic breast masses and the ACRIN 6666 experience. Radiol Clin North Am. 48(5):931-87, 2010
                                                  13. Loving VA et al: Targeted ultrasound in women younger than 30 years with focal breast signs or symptoms: outcomes analyses and management implications. AJR Am J Roentgenol. 195(6):1472-7, 2010
                                                  14. Raza S et al: US of breast masses categorized as BI-RADS 3, 4, and 5: pictorial review of factors influencing clinical management. Radiographics. 30(5):1199-213, 2010
                                                  15. Kim EK et al: Clinical application of the BI-RADS final assessment to breast sonography in conjunction with mammography. AJR Am J Roentgenol. 190(5):1209-15, 2008
                                                  16. Berg WA et al: Breast US: Cystic and probably benign breast lesions. Feig SA et al. Categorical Course Syllabus: Breast Imaging. Oak Brook: RSNA. 115-24, 2005
                                                  17. Hong AS et al: BI-RADS for sonography: positive and negative predictive values of sonographic features. AJR Am J Roentgenol. 184(4):1260-5, 2005
                                                  18. Graf O et al: Follow-up of palpable circumscribed noncalcified solid breast masses at mammography and US: can biopsy be averted? Radiology. 233(3):850-6, 2004
                                                  19. Gordon PB et al: Solid breast masses diagnosed as fibroadenoma at fine-needle aspiration biopsy: acceptable rates of growth at long-term follow-up. Radiology. 229(1):233-8, 2003
                                                  20. Stavros AT et al: Solid breast nodules: use of sonography to distinguish between benign and malignant lesions. Radiology. 196(1):123-34, 1995