Table of ContentsView AllTable of ContentsBreast Imaging ReportsBI-RADS ClassificationsBI-RADS Scoring and Breast DensityLimitations of BI-RADSSummaryFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Breast Imaging Reports
BI-RADS Classifications
BI-RADS Scoring and Breast Density
Limitations of BI-RADS
Summary
Frequently Asked Questions
A BI-RADS number reveals to your healthcare providers anything that may look potentially abnormal. It can also help them quantify how concerning the finding is. A change in the number from test to test can also help your healthcare providers more clearly detect a difference between the test results.
This article will explain the BI-RADS classifications and what they mean for your health.
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A mammogram, a low-energy X-ray examine of the breasts for diagnosis and screening, is the most common breast imaging test. It is often used in breast cancer screening. Abreast ultrasoundorbreast MRIcan also help identify breast cancer, and these tests are usually ordered when further evaluation is needed after a mammogram is reviewed.
Breast imaging reports should consist of a description of yourbreast densityand any abnormalities in your breasts or in the surrounding area. The report will include the size, location, shape, and any other details about a breast mass. It may also be compared to previous images, especially if you have ever had a concerning mass in the past.
One section on your report includes your BI-RADS score, which indicates the radiologist’s opinion about the absence or presence of breast cancer. Your score provides details about the possible diagnosis and whether additional testing is necessary.
Your BI-RADS score is part of your mammogram report. It will include information about the density of your breasts and whether there are abnormalities that need further testing. Your healthcare provider can explain your BI-RADS score when they discuss the results of your mammogram.
BI-RADS Classifications and What They Mean
Your BI-RADS score is a number between 0 and 6. Each number corresponds to a classification that estimates your breast cancer risk based on the imaging test.
Category 0: Incomplete
A score of 0 means that your mammogram or ultrasound didn’t provide enough information for a clear diagnosis. This does not necessarily mean your healthcare provider is worried about breast cancer.
This designation requires a follow-up imaging study, such as a mammogram or ultrasound obtained with special views, or a breast MRI. Your report may be classified with a 0 rating if apalpablebreast lumpisn’t imaging clearly, if scar tissue from a previous biopsy or surgery is interfering with the image, or if your breasts are dense.
Category 1: Normal
A score of 1 means that you do not have any suspicious masses orcalcificationsand your breast tissue looks healthy.
Category 2: Benign
A score of 2 is given when your breast tissue looks normal and any cysts,fibroadenomas(noncancerous tumors), or other masses appear benign.
A score of 1 or 2 does not mean that you are not at risk for breast cancer or could not have breast cancer. If your mammogram score falls into one of these categories, it is still important to continue regularly scheduledbreast examsand mammograms.
Category 3: Probably Benign
A score of 3 refers to a finding of uncertain significance. Short-term follow-up is ordered to make sure that the finding remains stable.
Category 4: Possibly Malignant
A score of 4 is reported when there are one or more suspicious lesions, masses, or calcifications. Abreast biopsyis often recommended to check the suspicious area.
Category 5: Malignant
A score of 5 means that there is a mass (or more than one mass) with an appearance of cancer. A biopsy is recommended to make an accurate diagnosis.
It’s important to note that even though this category is described as “malignant,” masses may appear cancerous but are related to a benign condition instead. Conditions such asadenosis,fat necrosis,radial scars, andmastitiscan sometimes look like cancer on a mammogram.
Category 6: Malignant Tissue
Category 6 is only used if tissue from a biopsy has been examined and found to be cancerous. If this is the case, treatment is necessary. This can includesurgery,chemotherapy, and/orradiation. The imaging test is being obtained as part of the treatment or follow-up plan.
BI-RADS reports also score breast density, which assesses how much fatty, glandular, and fibrous tissue you have in your breasts. Dense breast tissue can make it harder to detect breast cancer on a mammogram and also raises the risk of developing breast cancer.
On a mammography report, breast density is assigned to one of the following four categories:
As of September 10, 2024, the Food and Drug Administration (FDA) requires that all states inform patients of breast density in their mammogram reports, which should be described as either “not dense” or “dense.”
For younger women, children, and adolescents, the BI-RADS score may not be reliable.
It’s also important to note that your BI-RADS score doesn’t replace the opinion and insight of your healthcare provider or radiologist regarding your imaging tests. The number is not a substitute for a clinical exam.
Talk with your healthcare provider about your BI-RADS score and what it means for your health and future screenings or treatment.
Breast Cancer Risk—Beyond Mammograms
A Word From Verywell
Some breast images do not fit neatly into BI-RADS categories, and there may be a wide variety of findings even within the categories. While you may want to quickly find your BI-RADS number to make a conclusion about your health, it is important that you discuss your results with your healthcare provider—even if your breast imaging test turns out negative.
Screening mammograms are considered the most effective way to identify early-stage breast cancer and to get the most timely and definitive treatment. It is important to follow the guidelines for recommended screening tests, and follow-up tests if recommended. The BI-RADS score is a useful way to compare and standardize breast imaging studies. Just remember that it is only one of the many tools that your medical team uses to assess your health.
Frequently Asked QuestionsIn BI-RADS category 4, the word “suspicious” is used to address the possibility that cancer may be present. BI-RADS category 4 is separated into three sub-categories:4A: Low likelihood of cancer, between two and 10 percent4B: Potential cancer, between 10 and 50 percent4C: Greater likelihood of cancer, between 50 and 95 percentA BI-RADS score of 3, or “probably benign” means that there is something of uncertain significance on your mammogram, but that it is most likely not cancer. A follow-up mammogram may be recommended in a few months afterward. Malignant—or “probably malignant”—findings indicate that you will probably need a biopsy. This type of test involves taking a sample of tissue and looking at it more closely under a microscope to see if cancer is present.
In BI-RADS category 4, the word “suspicious” is used to address the possibility that cancer may be present. BI-RADS category 4 is separated into three sub-categories:4A: Low likelihood of cancer, between two and 10 percent4B: Potential cancer, between 10 and 50 percent4C: Greater likelihood of cancer, between 50 and 95 percent
In BI-RADS category 4, the word “suspicious” is used to address the possibility that cancer may be present. BI-RADS category 4 is separated into three sub-categories:
A BI-RADS score of 3, or “probably benign” means that there is something of uncertain significance on your mammogram, but that it is most likely not cancer. A follow-up mammogram may be recommended in a few months afterward. Malignant—or “probably malignant”—findings indicate that you will probably need a biopsy. This type of test involves taking a sample of tissue and looking at it more closely under a microscope to see if cancer is present.
3 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Park GE, Kim SH, Lee JM, Kang BJ, Chae BJ.Comparison of positive predictive values of categorization of suspicious calcifications using the 4th and 5th editions of BI-RADS.AJR Am J Roentgenol.2019;213:710-715. doi:10.2214/AJR.18.20866American Cancer Society.Understanding your mammogram report.U.S. Food and Drug Administration.Important Information: Final Rule to Amend the Mammography Quality Standards Act (MQSA).Additional ReadingAmerican College of Radiology.BI-RADS Atlas, 5th edition.
3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Park GE, Kim SH, Lee JM, Kang BJ, Chae BJ.Comparison of positive predictive values of categorization of suspicious calcifications using the 4th and 5th editions of BI-RADS.AJR Am J Roentgenol.2019;213:710-715. doi:10.2214/AJR.18.20866American Cancer Society.Understanding your mammogram report.U.S. Food and Drug Administration.Important Information: Final Rule to Amend the Mammography Quality Standards Act (MQSA).Additional ReadingAmerican College of Radiology.BI-RADS Atlas, 5th edition.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Park GE, Kim SH, Lee JM, Kang BJ, Chae BJ.Comparison of positive predictive values of categorization of suspicious calcifications using the 4th and 5th editions of BI-RADS.AJR Am J Roentgenol.2019;213:710-715. doi:10.2214/AJR.18.20866American Cancer Society.Understanding your mammogram report.U.S. Food and Drug Administration.Important Information: Final Rule to Amend the Mammography Quality Standards Act (MQSA).
Park GE, Kim SH, Lee JM, Kang BJ, Chae BJ.Comparison of positive predictive values of categorization of suspicious calcifications using the 4th and 5th editions of BI-RADS.AJR Am J Roentgenol.2019;213:710-715. doi:10.2214/AJR.18.20866
American Cancer Society.Understanding your mammogram report.
U.S. Food and Drug Administration.Important Information: Final Rule to Amend the Mammography Quality Standards Act (MQSA).
American College of Radiology.BI-RADS Atlas, 5th edition.
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