BI-RADS Update. Martha B. Mainiero, MD, FACR, FSBI Brown University Rhode Island Hospital

Transcription

1 BI-RADS Update Martha B. Mainiero, MD, FACR, FSBI Brown University Rhode Island Hospital

2 No Disclosures

3 BI-RADS History 1980s Quality Issues ACR Accreditation BI-RADS th Edition MRI, US January th Edition

4 In General More consistency of terms among 3 lexicons-mammo, US and MRI Elimination of descriptors that mean the same Can separate assessment from management

5 Lexicon MAMMOGRAPHY

6 Breast Composition A. Fatty B. Scattered C. Heterogeneously Dense D. Extremely Dense 1, 2, 3, 4

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8 Breast Composition-A The breasts are almost entirely fatty The breast is almost entirely fat (<25% glandular)

9 Breast Composition-B There are scattered areas of fibroglandular density There are scattered fibroglandular densities (approximately 25-50% glandular)

10 Breast Composition-C The breasts are heterogeneously dense, which may obscure small masses The breast tissue is heterogeneously dense, which could obscure detection of small masses (approximately 51%-75% glandular)

11 Breast Composition-D The breasts are extremely dense, which lowers the sensitivity of mammography The breast tissue is extremely dense. This may lower the sensitivity of mammography (>75% glandular)

12 Mass Shape Margins

13 Masses-Shape Oval Round Irregular Lobulated

14 Masses-Margin (no change) Circumscribed Obscured Microlobulated Indistinct Spiculated

15 Masses-Density (no change) High Density Equal Density Low Density Fat Containing Use Asymmetry not Density when describing tissue that is asymmetric but not a mass

16 Calcifications Morphology Distribution

17 Morphology: Typically Benign Skin Vascular Coarse or Popcorn- Like Large Rod-Like Round <1mm Punctate <0.5mm Rim Dystrophic Milk of Calcium Suture

18 Rim Eggshell Lucent centered

19 Intermediate Concern (amorphous coarse heterogeneous)

20 Morphology: Suspicious Amorphous Coarse Heterogeneous Fine Pleomorphic Fine-linear or Finelinear branching

21 Suspicious Calcifications 4B Amorphous Coarse Heterogeneous Fine Pleomorphic 4C or 5 Fine-linear or Finelinear branching

22 Calcification Size Dystrophic Coarse Popcorn Coarse Heterogenous Fine Pleomorphic

23 Calcifications: Distribution Scattered Clustered Diffuse Regional >2cm Grouped 2cm Linear Segmental

24 Architectural Distortion

25 Asymmetries Asymmetry Area of fibroglandular tissue on 1 view Usually summation artifact Global Asymmetry At least one quadrant asymmetric fibroglandular tissue Usually normal variant

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27 Asymmetries Focal Asymmetry 2 views, less than one quadrant 0.5-1% risk of malignancy if persists with no explanation after work up BI-RADS 3 on baseline study Developing asymmetry Focal asymmetry that is new or larger 15% risk of malignancy=bi-rads 4

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29 Solitary Dilated Duct Rare Finding Consider additional imaging evaluation and tissue diagnosis unless benign etiology demonstrated

30 Lexicon ULTRASOUND

31 Masses-Shape Oval Round Irregular Lobulated

32 Masses-Margin Abrupt transition zone Circumscribed Angulated Microlobulated Spiculated Indistinct Echogenic transition zone

33 Masses-Orientation Parallel Not parallel Wider-than-tall Taller-than-wide

34 BIRADS 3 Solid, oval, circumscribed, parallel Complicated cyst Clustered microcysts

35 Tissue Composition-Screening Homogeneous background echotexture -Fat Homogeneous background echotexture -Fibroglandular tissue Heterogeneous background echotexture

36 Elasticity Soft Intermediate Hard

37 Lexicon MRI

38 Amount of Fibroglandular Tissue A. Almost entirely Fat B. Scattered areas of Fibroglandular Tissue C. Heterogeneous Fibroglandular Tissue D. Extreme Fibroglandular Tissue Density is a radiographic term (Mammography)

39 Background Parenchymal Enhancement Minimal Mild Moderate Marked

40 Finding-Focus, Mass, NME

41 Findings Current Lexicon Focus <5mm Mass any size Non-Mass Enhancement (NME) Retired Foci (as lesions ) Non-Mass-Like Enhancement

42 Mass (Nearly same as Mamm/US) Shape -round, oval, irregular Margins Circumscribed Non-Circumscribed Spiculated Irregular (no indistinct)

43 Focal area Linear Segmental Regional Diffuse NME Ductal

44 Internal Enhancement Patterns Homogeneous Heterogeneous Clumped (think pleomorphic) Clustered Ring Stippled, reticular/dendritic Central enahncement Enhancing septations

45 Kinetic Curve Assessment Fast >100% Medium % Slow <50% Persistent >10% Plateau Washout 10%

46 Category 0-Avoid! Need prior study Rare instance that mammo/us may confirm benign lymph node or fat necrosis

47 Category 3? New unique focus with benign morphology and kinetics Mass on initial exam with benign morphology and kinetics Not BPE, NME

48 Category 6 When known cancer actually seen on study Not for use when biopsy of additional area recommended

49 Reporting Guidance

50 Wording the Report Comparison to previous examination may be irrelevant Management recommendations have been separated from assessment categories to provide better flexibility

51 Location Clock Face, Quadrant Depth, Distance from the nipple

52 Assessment Categories 1. Negative 2. Benign 3. Probably Benign 4. Suspicious 5. Highly Suggestive of Malignancy

53 BI-RADS 3 Management 6 month follow-up until 1 year stability Then 12 months until 2-3 year stability Keep assessment BI-RADS 3 while in follow-up* * Unless resolves or becomes clearly benign

54 Concordant Management Recommendations 1,2 Age appropriate screening 3 Six or Twelve month Follow-up 4,5 Biopsy should be performed in the absence of clinical contraindication 6 Recommend surgical excision when clinically appropriate"

55 Discordant Imaging and Management Recommendations: Examples Suspicious nipple discharge, mammo and US negative. Known positive margins, MRI negative Post BCT imaging benign, on q 6 month mammography

56 Questions?

57 Thank You