What percentage of BI-RADS 4 is cancer? (2023)

What percentage of BI-RADS 4 is cancer? (1)

If you have a BI-RADS 4, you may be wondering what percentage is cancer. In this article, you will learn how many BI-RADS 4 are benign and which are cancerous. Also, you will learn what it means when a BI-RADS 4 is highly suggestive of cancer.

How many BI-RADS 4 are benign?

The American College of Radiology (ACR) defined the BI-RADS classification system, which is a tool for separating benign breast lesions from those that may be cancerous. BI-RADS category 4 lesions are considered suspicious for malignancy. These lesions may require biopsy, but there is a high probability that they are benign.

However, this technique has limitations. It can cause false negative results in benign lesions, especially softer DCIS. It can also cause false positive results in lesions deeper in the body. Furthermore, it can lead to an incorrect diagnosis in lesions with dense parenchyma. But overall, BI-RADS 4 has high sensitivity and specificity.

Most BI-RADS 4 masses are benign. However, the ACR recommends that biopsy of category 3 lesions be required only if cancer is suspected. In contrast, biopsy of category 4 lesions is mandatory.

What does Birad 4 Suspect mean?

Getting a mammogram can be a stressful experience, from the discomfort of the procedure to the stressful days waiting for the results. Having a basic understanding of BIRADS, or breast imaging reports, is crucial to understanding mammography reports. Mayo Clinic-trained radiologist and assistant professor of radiology at Naval Medical Center San Diego, David Cline, MD, explains how BIRADS can affect your results.

(Video) BI-RADS Score: Results Explained

What BI Rad is highly suggestive of malignancy?

There are several different BI RADS, or breast imaging reports, and it's important to know the differences between them. For example, BI-RADS 4 is highly suggestive of cancer but carries a wide range of probabilities. Its subgroups are 4A, 4B, and 4C, and are used for findings highly suggestive of cancer that warrant further investigation.

Category 5 is the highest level of suspicion for malignancy and is associated with irregular spiculated masses. This category includes masses with or without calcifications. While most of these masses are harmless, a small percentage show worrisome patterns. If you suspect a mass, other imaging tests are recommended, including a breast MRI or ultrasound. This type of image can reveal abnormal blood flow and is highly suggestive of cancer.

In this case, a 39-year-old woman presented with a palpable mass in her left breast. An ultrasound showed a correlative mass of 7 mm. BI-RADS classified the mass as oval and not circumscribed. The follow-up ultrasound also detected a 2-cm irregular mass and an eccentrically thickened left axillary node. During the follow-up ultrasound, a biopsy was requested and the patient was referred for further evaluation.

What does moderate suspicion of malignancy mean?

The term "moderate suspicion of malignancy" refers to a range of possible conditions, including the presence of cancer or non-malignant conditions. In addition to the BI-RADS classification, the patient's symptoms and physical appearance can help determine the final diagnosis. For example, the BI-RADS 4 classification for breast lesions includes those that show a disproportionately high amount of fluid in the breast.

A breast imaging finding with a 2% probability of malignancy is considered suspicious and should be diagnosed by tissue biopsy. A small subset of these cases are classified as "most suspicious," meaning they have a 95% probability of malignancy. This BI-RADS category identifies high-risk areas for biopsy and treatment.

(Video) BI-RADS Category 4 & 5

In general, a biopsy is needed to make a diagnosis of cancer. Although this procedure cannot guarantee that a mass is benign, it is still a good idea to do so. It's also a good idea to have a follow-up every six months.

What does high suspicion of malignancy mean?

When a breast MRI finds a lesion that is highly suspicious for malignancy, a biopsy is recommended. BI-RADS, or Breast Imaging Data and Reporting System, provides a standardized lexicon for describing breast imaging findings. Highly suspicious lesions are those whose probability of malignancy exceeds 95%. Although these lesions are usually malignant, they can also be benign.

If a mammogram shows a mass with irregular contours, nonparallel orientation, or irregular border, BI-RADS 4a indicates a high suspicion of malignancy. The final evaluation will be based on the results of additional imaging studies. Patients should always have their old films available when undergoing further testing.

BI-RADS category 5 is reserved for lesions with a 95% probability of malignancy. These microcalcifications have an irregular appearance and are granular, linear, or branched.

What is a category 4 suspicious breast abnormality?

The BI-RADS classifications can help you differentiate between the different types of breast cancer. These categories include breast cancer, ductal carcinoma in situ, and invasive cancer. However, changes seen on an MRI may not be indicative of malignancy. These changes may be the result of other conditions, such as scarring or infection. Therefore, a biopsy is needed to confirm whether a particular change is cancerous.

(Video) What percentage of breast biopsies are cancer ? |Health Issues & Answers

A BI-RADS category four suggests that a breast mass is suspicious. A suspicious mass requires a circumscribed nonpalpable mass on baseline mammography and local compression imaging. Also, the mass should have a lumpy appearance and abnormal blood flow. A breast MRI can also be used to confirm a suspicious mass.

While a mammogram showing a suspicious category four abnormality is scary news, it's important to keep in mind that breast cancer is rare and not cause for alarm. There is an 80% chance that a category 4 abnormality will not develop into cancer. Therefore, it is important to discuss your concerns with your health care team so that you can find the right treatment plan.

What percentage of breast lesions are cancerous?

When assessing breast cancer risk, the malignancy rate is a critical factor. The malignancy rate in BI-RADS category 3 mammographic lesions is approximately five percent. By contrast, the rate for ductal carcinoma in situ (DCIS) is ten percent. As a result, the "wait and see" approach is not recommended. Instead, another biopsy should be performed, preferably by vacuum biopsy or open surgical excision.

The diameter of invasive breast cancers was 2.0 cm, while those containing pure DCIS were 3.5 cm. Likewise, the mean size of benign breast lesions was 1.3 cm. The radiologists used a three-step process to analyze the data. First, they calculated the percentages of breast lesions within 2 mm, 5 mm, and 1 centimeter. They then used chi-square and Student's t tests to identify differences between groups. Finally, they performed a subgroup analysis of FGT in small lesions and malignant lesions detected at screening.

Screening ultrasound revealed BI-RADS category 3 lesions in 14.6% of cases. Of the 1164 patients, eight (or 2.2%) of these lesions were cancerous. These findings contrast with the 0.4% risk of cancerous lesions detected by a normal mammogram. The study also found that when the strict ACRIN 6666 protocols were applied, 225 lesions were reclassified into BI-RADS categories two and four. The neoplasms detected were all very early and did not present lymph node metastases.

(Video) What do my screening results mean


What percent of BI-RADS 4 biopsy is positive? ›

So, the positive predictive value of BIRADS 4 breast abnormalities on a mammogram is between 23% and 34%. This is not all that high at all. Bi-rads 4 means 23% to 34% chance of cancer.

How many BI-RADS 4 are benign? ›

This means, BI-RADS category 4 lesions are associated with a highly variable rate of breast cancer, and with a high rate of benign (61.2%) (2), which might result in a high rate of unnecessary biopsy.

How many Birad 4 are malignant? ›

Results: Of the 118 BI-RADS 4 lesions, 74 lesions (62.7%) were benign and 44 lesions (37.3%) were malignant. The diagnostic sensitivity and specificity for US, US + CEUS, US + SWE, US + CEUS + SWE were 88.6% and 75.7%, 86.4% and 94.6%, 88.6% and 90.5%, 97.7% and 93.2%, respectively.

What is the treatment for BI-RADS 4? ›

VABB provides full excision in BI-RADS 4A and 4B lesions which have a relatively low probability of malignancy if lesions are small in size and benign, thus it inhibits complications and expenses of additional surgery.

How serious is Pirads 4? ›

Persistence of PI-RADS 4/5 predicts a higher risk of missed cancer, warranting prompt re-biopsy. While histological findings such as inflammation may underlie some PI-RADS 4/5 abnormalities, initial histology is a poor predictor of cancer likelihood on repeat biopsy.

Is biopsy needed for Birad 4? ›

BI-RADS category 4 means there is a suspicious abnormality on your breast imaging studies and a biopsy should be considered as a next step. Remember the only way to actually diagnose breast cancer is to obtain a tissue sample for evaluation by a pathologist, a doctor specializing in looking at tissue samples.


1. BI-RADS Assessment
2. Bi-Rads for Ultrasound
(Radiology Video - radiology made esay)
3. Is 6-month follow-up appropriate for BI-RADS 3 mammogram findings? (Breast Imaging)
4. TMT: BIRADS V Lesions by Dr Shanti Shetty
(Indian Radiologist)
5. Improving Specificity of Breast Ultrasound: BI-RADS 3 and 4A
6. 50-70% of Biopsies are Not Cancer
(Mercy Health)


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