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Bi Rads Analisis
Bi Rads Analisis
Bi Rads Analisis
Poster No.:
C-1089
Congress:
ECR 2013
Type:
Educational Exhibit
Authors:
Keywords:
DOI:
10.1594/ecr2013/C-1089
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Learning objectives
In this e-poster we are willing to remark the following key points:
To describe what to look for in the breast imaging studies in order to help
residents and non-specialized radiologists to lose their fear to the breast
interpretation.
Background
Breast Imaging Reporting and Data System (BI-RADS) was created for the ACR
(American Journal of Radiology) and it is considered the standard for reporting and
assessing the relative malignancy of breast abnormalities. The BI-RADS system was
created in 1992 with the next objetives:
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Imaging techniques:
Each technique used in breast imaging has a principal role in the diagnoses of breast
cancer. The principal indications are:
Mammography:
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Ultrasound:
MRI:
DESCRIPTORS
Mammography:
1.
2.
3.
4.
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1.
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1.
-Location
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Fig. 5: Lesion location: it describes the different breast planes and how to locate the
lesion using a clock disposition.
References: R. Rostagmo. El informe imagenolgico de mama. 1998
-Size
-Morfology: Round, oval, lobulated, irregular or architectural distortion.
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2. Calcification: It is the most common finding in mammography but also the most
difficult to identify. The mammography is the election technique to visualize calcifications.
Radiologists can find the calcification in lobules, ducts, interlobular tissue, vessels, skin,
or soft tissues.
It is important to see distribution, morfology, size and number of calcifications to give a
BI-RADS categorization.
Morfology
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References: - Zaragoza/ES
Distribution
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This finding includes fine lines or spiculations radiating from a point, focal retraction or
distortion of the edge of the parenchyma. If there is no traumatic or surgery history, biopsy
is always indicated.
4. Associated findings: they are not specific when they are alone, but in association with
other findings they are suggestive of malignancy.
Skin retraction
Nipple retraction
Axilar adenopathies
Trabecular thickening
Skin thickening
Ultrasound:
BI-RADS assessments for US are based on an analysis of six morphologic features of
solid masses. Whenever possible, the US lexicon uses terms similar to those used in
the mammography lexicon, with the primary overlap related to the shape and margins
of a mass.
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Special cases:
1.
2.
3.
4.
5.
6.
MRI:
MR imaging improves the detection and characterization of primary and recurrent breast
cancers. The assessment categories are based on BI-RADS categories developed
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for mammography. The breast imaging lexicon allows a standardized and consistent
description of the morphologic and kinetic characteristics of breast lesions. The margin
characteristics of a lesion and the intensity of its enhancement at MR imaging 2 minutes or
less after contrast material injection are currently considered the most important features
for breast lesion diagnosis.
If more than one imaging modality is performed, an integrated report with assessment
based on the highest level of suspicion must be used.
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TESTING YOURSELF:
In the next cases, which BI-RADS final categorie do you report and which
are your management recommendations?
CASE 1
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Multiple coarse calcifications, all of them with morphologies that are high suggestive of
benignity. The calcifications have a diffuse distribution.
-Case 4: BI-RADS 5, biopsy.
Multiple round, hyperdense nodules, some of them spiculated. In US, solid, round
complex nodule with indistinct margins, horizontal orientation and no shape. This is an
atypical case in mammography because this case was a patient with lymphoma and
breast metastases.
Images for this section:
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Fig. 13: Skin nodule: air interface round the nodule indicating that the lesion is located
in the skin.
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Fig. 25: Enhancement kinetics curves in MRI. There is 3 different types. Type I is a
pattern of progressive enhancement, with a continuous increase in signal intensity on
each successive contrast-enhanced image. Type II is a plateau pattern, in which an initial
increase in signal intensity is followed by a flattening of the enhancement curve. Type
III is a washout enhancement pattern, in which there is initial increase and subsequent
decrease in signal intensity
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Fig. 27: BI-RADS 0: You need additional imaging evaluation to give a final assessment.
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Fig. 28: BI-RADS 1: predominant fat pattern. There is nothing to comment on.
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Fig. 30: Dense lobulated nodule with coarse calcifications. These are typical of
fibroadenoma. In this case it is not necessary any subsequent conduct. The
recommendation is normal follow-up.
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Fig. 29: BI-RADS 2: benign nodule. In mammogrphy, we can see an isodense nodule,
with oval morfology and with partially indistinct margin. In ultrosund, it is oval, parallel to
the skin, anechoic, circunscribed with posterior enhancement, compatible with a cyst.
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Fig. 31: Mammogrphy shows an isodense nodule, with oval morfology and with partially
indistinct margin. In ultrosund, the nodule is oval, parallel to the skin, hypoechoic and
circunscribed. Bi-RADS 3, probably benign, 6 months follow-up.
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Fig. 32: Mammogrphy shows a dense nodule, with oval morfology and with partially
indistinct margin (arrow in mammography). Ultrasound shows a large cyst with posterior
echogenic components (arrows). BI-RADS 4, Biopsy is recommended.
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Fig. 33: Mammography shows a dense, lobulated nodule, with microlobulated margins.
Ultrasound demostrate an oval hypoechoic nodule, not parallel to the skin,with
microlobulated margins, echogenic halo and posterior shadowing. This lesion is probably
malign, so biopsy is recommended.
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Conclusion
Some things that all radiologists should know to read breast imaging easily:
References
1- American College of Radiology. BI-RADS-Mamography. 4th ed. In: Breast Imaging
Reporting and Data System (BI-RADS) atlas. 4th ed. Reston, Va: American College of
Radiology, 2003.
2- American College of Radiology. BI-RADS-Ultrasound. 1st ed. In: Breast Imaging
Reporting and Data System (BI-RADS) atlas. 4th ed. Reston, Va: American College of
Radiology, 2003.
3- American College of Radiology. BI-RADS-MRI. 41st ed. In: Breast Imaging Reporting
and Data System (BI-RADS) atlas. 4th ed. Reston, Va: American College of Radiology,
2003.
4- Harvey JA, Nicholson BT, Cohen MA. Finding early invasive breast cancers: a practical
approach. Radiology. 2008 Jul;248(1):61-76.
5- Raza S, Goldkamp AL, Chikarmane SA, Birdwell RL. US of breast masses categorized
as BI-RADS 3, 4, and 5: pictorial review of factors influencing clinical management.
Radiographics. 2010 Sep;30(5):1199-213
6- Raza S, Chikarmane SA, Neilsen SS, Zorn LM, Birdwell RL. BI-RADS 3, 4, and
5 lesions: value of US in management--follow-up and outcome. Radiology. 2008
Sep;248(3):773-81.
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7- Mann RM, Kuhl CK, Kinkel K, Boetes C. Breast MRI: guidelines from the European
Society of Breast Imaging. Eur Radiol. 2008 Jul;18(7):1307-18.
8- Macura KJ, Ouwerkerk R, Jacobs MA, Bluemke DA. Patterns of enhancement
on breast MR images: interpretation and imaging pitfalls. Radiographics. 2006 NovDec;26(6):1719-34;
Personal Information
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