Normal assessment but interpreter chooses to describe a benign finding in the report such as:

• Calcified fibroadenomas

• Multiple secretory calcifications

• Fat-containing lesions such as oil cysts, lipomas, galactoceles, and mixed density hamartomas

• Intramammary LN

• Architectural distortion related to known prior surgery

Validated for multiple oval bilateral masses with mostly (>75%) circumscribed partially obscured margins on mammo when there is at least 3 total similar findings with at least 1 in each breast.

• Not applicable with a dominant mass or suspicious features

• Excludes palpable masses. If you have palpable masses, you MUST get US. 

Typically benign calcs include milk of calcium, secretory, dystrophic, and vascular calcs.

Summary of lesions appropriate for BR3 based on imaging modality (on baseline mammo)

• Mammography:

  • Noncalcified NONPALPABLE circumscribed oval mass

  • Solitary group/cluster of round/punctate calcs

  • Focal asymmetry w/o calc or distortion - nonpalpable w/o US correlate that becomes less dense on spot compression view

  • Other: developing vascular calcs, fat necrosis, hematoma, LNs

• US:

  • Solid oval mass w/ circumscribed margins, parallel orientation, hypoechoic, no posterior features

  • Isolated complicated cyst

  • Cluster microcysts that are too small or deep in postmenopausal women not on HRT

  • Other: fat necrosis, hematoma, architectural distortion after surgery, LAD after vaccination

    • Suspected fat necrosis or hematoma may be followed in a shorter interval, as evolution/resolution is likely (4-8 weeks)

• MRI:

  • NME

  • Oval circumscribed mass w/ associated T2 hyperintensity

  • Foci w/ T2 hyperintensity

Assigning category 3 to a finding identified at screening mammography is inappropriate. A comprehensive diagnostic workup, including magnification views for calcifications and US of masses and asymmetries, may downgrade the finding as benign or prompt a biopsy recommendation if suspicious features are identified.

Regardless of the imaging modality used, radiologists should consider certain patient-related factors when assigning category 3, such as the indication for the examination and the patient’s risk for breast cancer, age, possible anxiety from uncertainty and required follow-up examinations, and likelihood of compliance with surveillance imaging.

BR3 is most frequently used on a baseline exam when there are no priors for comparison

Finding is usually followed for 2 years (6, 12, and 24 months) on the modality that best depicts the finding, assuming stability at each examination

• If there is a suspicious change (new irregular margin) or excessive growth (>20% in 6 months) at any follow up, bx should be performed.

When to downgrade to BR2?

• Mass/complicated cyst resolves

• Calcs are clearly milk of Ca on magnification views

• Calcs are vascular

• Grouped calcs form a circle, consistent w/ calcification in the wall of an oil cyst.

When to upgrade to BR4?

• Significant increase in size of mass (>20% in 6 months)

• Development of more suspicious features

• Increase in number of calcs

• A different suspicious finding is noted.

When to use category 4A?

• Partially circumscribed mass suggestive of atypical fibroadenoma

• Palpable solitary complex cystic/solid cyst

• Probably abscess

When to use category 4B?

• Group amorphous or fine pleomorphic calcs

• Nondescript solid mass w/ indistinct margins

When to use category 4C?

• New group of fine linear calcs

• New indistinct irregular solitary mass

Reserved for findings that are classic for CA (>95% chance of malignancy)

• A spiculated irregular high-density mass

• Segmental / linear arrangement of fine linear calcs

• Irregular spiculated mass w/ associated pleomorphic calcs