Professional Documents
Culture Documents
Bi-Rads 6 Ed
Bi-Rads 6 Ed
• Research/outcomes/benchmarks
• Starts: “Diagnostic: Current Breast Cancer (response to treatment)”;
ends as B4/5
• Starts: “Follow-up Category 3”; ends as B4…or B2
• More detail, better data
Update overview
• Expected release: 2023
American College of Radiology®
• Captions include in capital letters the dominant findings and in many cases
additional descriptors in small letters
• Pathology included where available
• Management based on most suspicious feature
Digital Breast Tomosynthesis
The Guidance chapter first introduced in the Fourth
edition in response to many questions and
suggestions concerning terminology and auditing
• On craniocaudal (CC) views they are often less evident and appear as
round, smudgy deposits
Solitary Dilated Duct
Breast Ultrasound
Jessica W. T. Leung, MD, Chair
Jay A. Baker, MD
Regina J. Hooley, MD
Vilert A. Loving, MD
Jocelyn A. Rapelyea, MD
Fibroadenoma
Radial Antiradial
Invasive Ductal Carcinoma
Image Source: Jay Baker, MD (ACR BI-RADS)
Echogenic Rind
• Distinct (and opposite) from echogenic pseudocapsule
• Uniformly thin
• Oval shape suggesting benignity
• Less sharply demarcated, thicker, more variable in thickness
• Mass of any shape
• Inclusion of echogenic rind in measurement of mass
• Best correlation with histology1,2
1. Joekel J, et al. Breast Cancer Res Treat 2016; 156:311-317
2. Meier-Meitinger M, et al. Eur Radiol 2011; 21:1180-1187
Echogenic Rind
• Introduction of new element in associated features
• Thick band of echogenic tissue surrounding all or part of a breast
mass
• Disrupts texture of normal tissue surrounding the mass
• Likely represents desmoplastic reaction or peritumoral edema
• High PPV for malignancy1-3 biopsy unless proven benign
• Notable exception: fat necrosis
1. Constantini M, et al. J Ultrasound Med 2006; 25:649-659
2. Durmus T, et al. Ultraschall Med 2014; 35:547-553
3. Watanabe T, et al. J Med Ultrason 2021; 48:71-81
Echogenic Rind
Fat Necrosis
Image Source: Jay Baker, MD (ACR BI-RADS)
Given the current advances in US equipment capabilities
and knowledge of breast US, there is increasing
awareness and identification of abnormalities at US that
do not rise to the criteria of a mass.
Nonmass
• Introduction of new category of sonographic finding
• Lacks the 3-dimensionality of a mass
• Identifiable in at least 2 planes, but may be primarily visualized
in 1 plane only
• Lacks definable shape and margin for assessment
• If malignant, histology more likely to be in-situ (vs invasive)
carcinoma
Nonmass
• Echogenicity
• Hypoechoic, isoechoic, hyperechoic, mixed echogenicity
• Distribution
• Regional, focal, linear, segmental
• Shape/Margin
• Not applicable as shape/margin not characterizable
• Orientation (?)
• Parallel, antiparallel
Nonmass
• Associated imaging variables
• Echogenic rind, architectural distortion, posterior shadowing,
hypervascularity, ductal extension or abnormal ductal changes,
calcifications = suggest malignant
• Presence of small cysts suggests benign1
• Associated clinical variables
• Probability of malignancy increases in setting of nipple
discharge or palpability
Breast MRI
Wendy DeMartini, MD, Chair
Roberta Strigel, MD, MS, Vice-Chair
Katja Pinker, MD, PhD
Habib Rahbar, MD
Lilian Wang, MD
Cortical Effacement
thickening of hilum
Axillary Lymph Nodes: Describe Levels (I-III)
• Important anatomic staging
information
• Prognosis and management Pec Minor
Mass =
Biopsy Proven NME
Malignancy 7 cm
American College of Radiology®
• Follow-up and
Outcome Monitoring
New name!
Same mission:
Provide a universal recipe for practices and individuals to
evaluate, adjust and improve performance for patients.
Benchmarks Updated
Screening Diagnostic
2D Mammography ✔️ ✔️
DBT ✔️ ✔️
Ultrasound ✔️ ✔️
MRI ✔️ ✔️
Updated Table of
Screening Vs Diagnostic for Audit
Screening Audit Flowchart Example
Diagnostic Audit Flowchart Example
Adding BI-RADS 3 to Basic Audit
• New addition to the basic clinically relevant audit
• Count only initial BI-RADS 3 assessments
• Provide internal feedback for utilization and PPV
• Encourage additional collection and publication of data for US
and MRI
BI-RADS 3 Audit Flowchart Example
BWUP: Benign with Upgrade Potential
• “High risk” has a new name
• High risk histology list is updated
∙Lobular carcinoma in situ
∙Atypical ductal hyperplasia
∙Atypical lobular hyperplasia
∙Peripheral duct papilloma
∙Phyllodes tumor
∙Radial scar/Complex sclerosing lesion
∙Flat epithelial atypia
BWUP: Benign with Upgrade Potential
• “High risk” has a new name
• High risk histology list is updated
∙Lobular carcinoma in situ
∙Atypical ductal hyperplasia
∙Atypical lobular hyperplasia
∙Peripheral duct papilloma
∙Phyllodes tumor
∙Radial scar/Complex sclerosing lesion
∙Flat epithelial atypia
But wait, there’s more…
• What not to audit
• Guidance and FAQ’s
• PeterEbyMD@proton.me
Update overview
• Expected release: 2023