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Mammo

Mammography follow-up

BI-RADS assessment categories and recommended management for mammographic findings.

Screening

BI-RADS 0 — incomplete

  • Recall for additional imaging (spot compression, magnification views, or US).
  • Compare with prior exams when available before final assessment.
  • Aim to complete workup and re-assign a final BI-RADS category within 30 days.

Source: ACR BI-RADS 5th edition

Screening

BI-RADS 1–2 — negative / benign

  • Routine annual screening mammography (age- and risk-appropriate).
  • Document benign findings (calcified fibroadenoma, simple cysts, lipomas) to avoid future recall.

Source: ACR BI-RADS 5th edition

Screening

BI-RADS 3 — probably benign

  • Short-interval follow-up mammography at 6 months.
  • Then 12 and 24 months to confirm 2-year stability.
  • <2% malignancy risk; biopsy if any interval change.

Source: ACR BI-RADS 5th edition

Diagnostic

BI-RADS 4 — suspicious

  • Tissue diagnosis recommended (image-guided core biopsy).
  • Subcategories 4A (>2–10%), 4B (>10–50%), 4C (>50–<95%) stratify malignancy risk.
  • Radiologic-pathologic concordance review after biopsy is mandatory.

Source: ACR BI-RADS 5th edition

Diagnostic

BI-RADS 5 — highly suggestive of malignancy

  • ≥95% malignancy risk — core biopsy and surgical/oncology referral.
  • Discordant benign pathology requires repeat biopsy or excision.

Source: ACR BI-RADS 5th edition

Diagnostic

BI-RADS 6 — known biopsy-proven malignancy

  • Assigned after biopsy confirms malignancy, before definitive therapy.
  • Used for neoadjuvant chemotherapy response or pre-operative localization workup.

Source: ACR BI-RADS 5th edition

Diagnostic

Suspicious microcalcifications

  • Fine pleomorphic, fine linear, or linear branching morphology → BI-RADS 4B/4C.
  • Stereotactic vacuum-assisted core biopsy is preferred technique.
  • Specimen radiograph required to confirm retrieval of calcifications.

Source: ACR BI-RADS lexicon

Diagnostic

Architectural distortion

  • Without known surgical/trauma history — biopsy regardless of mammographic correlate.
  • If no US correlate, tomosynthesis-guided or stereotactic biopsy is appropriate.
  • Radial scar / complex sclerosing lesion on core → consider surgical excision.

Source: ACR BI-RADS / SBI guidance

Supplemental screening

Dense breast tissue (categories C/D)

  • Discuss supplemental screening US or MRI based on lifetime risk.
  • Consider abbreviated breast MRI in intermediate-to-high-risk women.
  • FDA requires breast density notification in screening reports.

Source: ACR / SBI dense breast guidance

Screening

High-risk screening (lifetime risk ≥20%)

  • Annual screening MRI in addition to annual mammography starting at age 25–30.
  • Includes BRCA1/2, TP53, PALB2, prior chest radiation age 10–30, strong family history.
  • Consider risk-reducing strategies and genetic counseling referral.

Source: ACS / ACR high-risk screening guidelines

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