Chapter 7 – Breast


The Breast Imaging – Reporting and Data System

This ACR established schema is in its fifth edition.  It has been established and deployed in an attempt to standardize the information included in a breast imaging report and to provide a methodology for reviewing outcomes based upon standardized descriptors of imaging findings and standardized management strategies.  The data from this schema can be used to evaluate positive and negative biopsy results and improve the quality of patient care.

After detecting and describing the abnormal findings present on the imaging examination the final breast imaging report (mammography, ultrasound, magnetic resonance imaging) will include an assessment that reflects the findings of the examination, provides a management recommendation, and is associated with an estimate of the potential risk of malignancy.

Table 1: BiRads Classification with Suggested Management and Likelihood of Breast Cancer (adapted)

Category Management Likelihood of Cancer
 0 – Incomplete Imaging Assessment Recall or arrange to complete the imaging assessment Unknown
 1 – Negative Continue Screening No > General population
 2 – Benign Findings Continue Screening No > General population
 3 – Probably Benign Findings  Short-term imaging follow-up (6 months) < 2% Likelihood
 4 – Suspicious Tissue diagnosis > 2% – 95% Likelihood

Subtypes 4A, 4B, 4C with progressively greater likelihoods of malignancy

 5 – Malignancy Very Likely Tissue diagnosis > 95% Likelihood
 6 – Known, biopsy proven, malignancy Treatment of Malignancy 100%