Bi-rads descriptors for the classification of breast lesions and their application for non-palpable breast lesions

Abstract

The objective of this article is to carry out a review of the updates of the BI-RADS descriptor system, being that of the year 2013 the fifth and last version of the radiological atlas of images and BI-RADS report. This new version incorporated modifications in the management, nomenclature and descriptors of different lesions and, among these, non-palpable breast lesions. The BI-RADS system can be used in mammography, ultrasound and magnetic resonance imaging. Normally, when the radiologist performs several tests, he assesses them jointly, issuing a single final category, based on the highest level finding observed. The American Cancer Society (ACS) recommends annual screening mammography starting at age 40. For women with a positive family history of breast cancer, annual screening begins at age 30. In this context, the establishment of the BI-RADS categories of the American College of Radiology has been an important milestone in the classification of breast findings, by allowing the establishment of guidelines for their diagnosis. Within the BI-RADS classification, category 1 corresponds to the normal breast, without lesions; category 2 to inconsequential benign lesions; category 3 to probably benign lesions, with a positive predictive value (PPV) for cancer of less than 2%; category 4 to suspicious lesions with a PPV variable between 2 and 85%, and finally category 5, highly suspicious of malignancy, with a PPV greater than 85%. Obviously, it does not make sense to biopsy lesions classified as category 1 or 2, however, it is necessary to biopsy category 4 or 5 lesions given their moderate or high PPV for cancer. In this paper we review the role of each biopsy technique, the BIRADS classification, its importance, as well as its role in non-palpable breast lesions.