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Breast cancer: understand BIRADS classification
The term BIRADS is an acronym for Breast Imaging Reporting and Data System , that is, it is an international systematization for mammary evaluation, interpretation of the examination and making reports of breast imaging specifically for the breast. This classification should be applied in the mammography, mammographic and nuclear magnetic resonance reports of the breasts and assures greater reliability to the examination. BIRADS is a standardization manual that can be used to analyze the characteristics of breast lesions (cysts, nodules, calcifications) ) and estimate the risk of breast cancer. We have already pointed out that most nodules and mammary microcalcifications are benign, that is, the presence of nodules or microcalcifications does not in any way mean that the patient has breast cancer.
The categorization is used following: the medical professional who is doing and / or analyzing the imaging exam will evaluate the changes present in the test and classify them within the BIRADS criteria. The categorization is separated by grades ranging from zero to six:
BIRADS
Significance | Breast cancer risk | Conduct | 0 |
Limited examination - incomplete assessment | No it is possible to estimate | Needs additional examinations | 1 |
Normal examination | Very low | Annual control | 2 |
Benign changes | Very low | Annual control | 3 |
Probably benign test | 2% | Half-yearly control for a period of time | 4 |
Suspected lesion for cancer | 20% | Requires biopsy | 5 |
Highly suspected lesion for cancer | 95% | Need for biopsy | 6 |
Injury already diagnosed with cancer | 100% | Cancer treatment | BIRADS 1 and 2 |
The most common are normal exams - grades 1 and 2 - pass to grades 3 and 4 according to aging, and may be associated with benign and malignant breast diseases. That is, during the life of the woman there may be some changes in the breast that require a more specific conduct on the part of the doctor.
BIRADS 3
Women whose breast examination has a grade of 3 must make a semiannual check for 1 to 2 years. If they are stable in this period, they may be reclassified to BIRADS 2. Despite having an estimated cancer risk of 2%, biopsy is not a mandatory requirement, since the biopsy itself can cause problems and harm to the patient. The most recommended course in this group, as recommended by the Brazilian Society of Mastology, the Brazilian Society of Oncologic Surgery and other worldwide medical societies, is the semi-annual control with a specialist physician.
BIRADS 4
Women who present BIRADS 4 require of biopsy. The biopsy may be thin needle or thick needle (
core biopsy or mammotomy) depending on each case. From this biopsy we could have the following situations: Benign report: just control. You will have your mark lowered to 2
- Suspicious report (presence of change): minor surgery may be needed to acquire more material and to rule out cancer suspected
- Malignant report: oncologic surgery required
- BIRADS 5
A mammogram or other breast exams with BIRADS 5 shows that the suspicion of cancer in this group is very high. In this case, they necessarily need surgery. The doctor or doctor may even opt for a biopsy before surgery, but this lesion needs to be completely removed surgically.BIRADS 6
In this case, the woman is just following up. For some reason the doctor needed to do more breast exams, and the principle tests will already have a note 6 because of the standardization of the BIRADS manual.
The results may change?
It is important to note that the notes may change over time as the cancer progresses or regresses. For patients with suspected or diagnosed breast cancer (BIRADS 4 or 5), the exams are expected to come with BIRADS 2 reports after completing treatment, denoting that the problem is actually eliminated.
Another frequent Imaging examinations may have BIRADS classification completely different from each other, for example, mammography may be note 2, ultrasound note 3 and mammary resonance note 4 - because the classification is applied for each examination independently. In these cases, the doctor will evaluate the best course of action.
Another possibility is BIRADS 0, which translates to the fact that the exam detected something but could not solve the problem. This classification is not a cause for concern or tranquility, since the examination did not serve to arrive at an accurate diagnosis. In this classification it is necessary to perform additional tests.
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