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BIRADS 3 LESIONS BREAST MR
Kavita Dhamanaskar Radiologist @ Juravinski hospital, Hamilton
Disclosures
�N
one relevant
Learning objectives
�D
efinition and Characterization of BI-R
ADS 3
lesions on MR
�Correlation w
ith conventional imaging
�Follow
up protocols
BI-R
ADS 3
category on MR
�“A finding assessed using this category should have �����
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��������� ����characteristically benign finding.
ACR B
I-���
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BI-R
ADS 3
lesions on MR
: Challenges �
No strong data for definitive characterization of B
i-rads 3 lesions
�D
ifferences in study design and criteria from published studies
�R
isks and benefits of short term follow
- up –
Patient anxiety and non compliance
–H
igh risk lesion mim
icks
BI-R
ADS 3
Lesions
FOCI
NM
E- Non M
asslike enhancement
MASS
Birads 3
lesions on MR
FO
CI
�Foci are defined as sm
all dots (</=
5m
m) of enhancem
ent that are unique and stand out from
the BPE.
�They are too sm
all to be accurately assessed with respect
to margin or internal enhancem
ent.
•ACR
BI-R
ADS®
ATLAS — BB
REAST M
RI
BI-R
ADS 3
Birads 3
lesions on MR
FO
CI
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�5
mm
UUnique focus w
ith washout characteristics –
Birads 3
lesion requiring short interval follow
up MR
(6m
onthsG�77
•Liberm
anL., M
ason G., M
orris E.A
., et al: Does size m
atter? Positive predictive value of M
RI-detected breast
lesions as a function of lesion size. AJR
Am
J Roentgenol2006; 186: pp. 426-430
**E
byP.R
., DeM
artiniW.B
., Gutierrez R
.L., et al: Characteristics of probably benign breast M
RI lesions. A
JR A
m J
Roentgenol2009; 193: pp. 861-867
�Clauser Q�������V�
�)WG- show
ed that all foci that enlarged on follow up, w
ere �
��������7
–166 H
IGH
–RISK wom
en –
68 foci were detected and follow
ed. Majority stable, few
disappeared. –
3% enlarged – w
ere malignant
�O
verall malignancy rate in biopsied foci can be upto �
*�
>�Hence patient’s risk
���� ���� ����� ������������� ��
����� ���77
Birads 3
lesions on MR
FO
CI
P Clauser et al. Radiol X
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aza S et al., Acad ��� � ����
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77
W
einstein SP et al.,Radiology �
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44
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7
�5
mm
UUnique (bright) focus w
ith/without w
ashout characteristics –
–Birads 3 lesion requiring short interval follow
up MR (6m
onths). –
If enlarging on follow up- w
arrants BIOPSY B
irads 3 lesions on M
R
FOCI
P Clauser et al. Radiol X
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Raza S et al., Acad �
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adiology ��)�
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a R, Sung J, Lee C, et al. Clin R
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BI-R
ADS 3
Lesions
FOCI
NM
E- Non M
asslike enhancement
MASS
BI-R
ADS 3
lesions N
ME- N
on Mass-like Enhancem
ent �
Overall M
R interpretation trend is tow
ards lower num
ber of cases designated as B
irads 3
�Som
e reasons- –
Bilateral NM
E now labelled BPE and belongs to BI-RAD
S 1 (ACR BI-RADS
lexicon)
�N
ME that is unique and separate from
the overall background enhancement
should undergo assessment based on m
orphology and kinetics. –
Not included are segm
ental, linear or clumped nodular enhancem
ent (BI-RADS 4)
•ACR
BI-R
ADS®
ATLAS 5th ��� ���
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�— BB
REAST M
RI
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��9 ���� ������
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BI-R
ADS 3
lesions- NM
E- Non M
ass-like Enhancement
MR
Bx-
Benign breast
tissue w
proliferative change
BI-R
ADS 3
Lesions
FOCI
NM
E- Non M
asslike enhancement
MASS
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ark / Non enhancing internal septations '
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Macura K
J, et al., Radiographics �
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ADS 3
lesions M
ass
Bi-�
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Stable bilateral fibroadenomas
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�Targeted U
ltrasound- –
Allows further characterization/confirm
ation –
FU X 2 yrs to establish benignity
������ ����1���
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enhancement characteristics
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BI-R
ADS 3
lesions M
ass
LEFT breast- MU
CINO
US CA
And bilateral smaller FA
Avoid BI-R
ADS 3
�
Chronic inflamed cysts- w
ell defined thin rim enhancem
ent (birads �G
�Fat N
ecrosis- same density as fat w
ith thin rim enhancem
ent. Hx of
surgery (bi-Rads �
G>�$��� ����9������������- Birads ^
���������� ��exclude recurrence.
�Intra-m
amm
ary LN- (�
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BI-R
ADS 3
Cancer yield ??
�TH
E EVIDEN
CE
Summ
ary of Literature on MR
Imaging–
detected Probably B
enign (BI-R
ADS Category 3
) Lesions
*Num
bers in parentheses are percentages. †Num
bers in parentheses are raw data.
Radiology. 2016 S
ep;280(3):707-15.doi: 10.1148/radiol.2016151548. Epub
2016 Apr 18.
Characteristics, M
alignancy Rate, and Follow
-up of BI-R
ADS C
ategory 3 Lesions Identified at Breast M
R
Imaging: Im
plications for MR
Image Interpretation and M
anagement.
Chikarm
aneS
A1,B
irdwell R
L1,P
oole PS
1,Sippo
DA
1,Giess
CS
1.
“Probably benign” interpretations in H
igh risk wom
en at MR
�7First study to determ
ine the results of probably benign lesions on FU.
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AD 3
interpretation given
�Characteristics of B
i-rads 3 - '
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�FU
usually 6 m
onths first time. Subsequent 6
months- )
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*Liberman
L, Morris E
A, B
enton CL, et al. P
robably benign lesions at breast magnetic resonance im
aging:prelim
inary experience in high-risk wom
en. Cancer 2003;98(2):377–88.
Freq. of malignancy in probably benign
lesions at CE-X�
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–M
asses- 37 –
Non-m
ass enhancement- 59
–Foci of enhancem
ent- 47
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�yrs followup
–83 (78.3%
) of 106- stable –
23 (21.7%) – had tissue diagnosis –
–18 had benign pathology, 2 had AH
& 1 had D
CIS
�B
I-RAD
S 3 lesions- )
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�9�������–�����
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�G
W
iensteinet al R
adiology:Volume 255: N
umber 3—
June 2010
BI-R
ADS 3
lesions �
Study by Lourenco et al describes -Frequency, Lesion Type, and Rate
of Malignancy
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R exam
s studied
�Y)
���������9������
�Characteristics –
125- foci (2- 4mm
size) Cancer Yield- 0.8%
–52 non m
ass like (6- 35mm
) Cancer Yield- 3.8%
–171 m
asses with sm
ooth margins (5-20m
m) Cancer Yield- 1.2%
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. Mainiero, M
D. J. M
agn. Reson>�$�
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BI- R
ADS 3
Breast M
R category
Notes:
�B
reast MR
comm
only used in higher risk wom
en
�Low
specificity of MR
in small lesions w
ith overlap between
high risk lesions and benign lesions
�Learning curve of radiologists
�B
aseline Study Vs follow up im
aging
�A desirable goal for the frequency of m
aking category 3
���������������X
�$�������������)�
�>
�As experience grow
s and with internal audits this num
ber �� ��������
-*�
As per published studies/literature
BI- R
ADS 3
Breast M
R category
Notes:
�M
amm
ogram and U
ltrasound- useful to ultimately assign a B
I-RAD
S 3
for a first time detected finding on B
aseline or screening MR
�M
asses have highest correlation on ultrasound
�Foci and N
ME not usually identified and can go straight to M
R follow
up or M
R biopsy (high risk)
BI- R
ADS 3
Breast M
R category
Notes:
Summ
ary �
BI-R
ads 3 category is not easy to assign and requires a m
ethodological approach
�Com
monly 3
types
–Foci
–N
ME
–M
ass
�Correlation to prior im
aging including MR
, mam
mogram
s and ultrasound would help
in accurate characterization and BI-R
ADS designation
�Clinical characteristics and risk factors need to be taken into account
�1 �� 8
��9���������~�W��
����������������� �����W��
���������������������� ��)�� ��
�years to establish benignity
�For N
ME attributable to phase of m
enstrual cycle may consider repeat M
R in 6
-Y�
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