Birads US 3 - 5
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Transcript of Birads US 3 - 5
Birads 3-5 Ultrasound
BIRADS
• 3 - Probably benign: 6,12,(18),24 month
• 4 - Biopsy (A,B,C) 2-95% risk• 5 - Cancer (>95%)
BenignMalignant
•Oval•Parallel to skin•Circumscribed
•Sharp boundary•Hyper echoic
•Irregular / round•Not parallel•Indistinct, angular, spiculated•Echogenic halo•Mixed echopattern•Posterior shadow
Orientation and shape.
Oval 16% malignant
©2010 by Radiological Society of North America
Benign•Oval•Parallel to skin•Circumscribed•Sharp boundary•Hyper echoic
Orientation and shape.
Round 60% malignant
©2010 by Radiological Society of North America
Malignant•Irregular / round•Not parallel•Indistinct, angular, spiculated•Halo•Mixed pattern•Shadow
Orientation and shape.
Irregular 60% malignant
©2010 by Radiological Society of North America
Malignant•Irregular / round•Not parallel•Indistinct, angular, spiculated•Halo•Mixed pattern•Shadow
Margins.
Raza S et al. Radiographics 2010;30:1199-1213
©2010 by Radiological Society of North America
Benign•Oval•Parallel to skin•Circumscribed•Sharp boundary•Hyper echoic
Margins.
Microlobulated
©2010 by Radiological Society of North America
Malignant•Irregular / round•Not parallel•Indistinct, angular, spiculated•Halo•Mixed pattern•Shadow
Margins.
Indistinct
©2010 by Radiological Society of North America
Malignant•Irregular / round•Not parallel•Indistinct, angular, spiculated•Halo•Mixed pattern•Shadow
Margins.
Angular: 60% malignant
©2010 by Radiological Society of North America
Malignant•Irregular / round•Not parallel•Indistinct, angular, spiculated•Halo•Mixed pattern•Shadow
Margins.
Spiculated: 86% malignant
©2010 by Radiological Society of North America
Malignant•Irregular / round•Not parallel•Indistinct, angular, spiculated•Halo•Mixed pattern•Shadow
Internal echo pattern.
Raza S et al. Radiographics 2010;30:1199-1213
©2010 by Radiological Society of North America
Hypo echoic•Most common•Compare to fat
Internal echo pattern.
Raza S et al. Radiographics 2010;30:1199-1213
©2010 by Radiological Society of North America
Iso echoic•Compare to fat
Internal echo pattern.
Raza S et al. Radiographics 2010;30:1199-1213
©2010 by Radiological Society of North America
Hyper echoic•Mostly benign•Compare to fat
Posterior acoustic features.
Raza S et al. Radiographics 2010;30:1199-1213
©2010 by Radiological Society of North America
Enhancement•Indeterminate•SonoCT off
Posterior acoustic features.
Shadow
©2010 by Radiological Society of North America
Malignant•Irregular / round•Not parallel•Indistinct, angular, spiculated•Halo•Mixed pattern•Shadow
Benign NPV
•Oval•Parallel to skin•Circumscribed
•Sharp boundary•Hyper echoic
84%78%90%
Malignant PPV
•Irregular / round•Not parallel•Indistinct, angular, spiculated•Echogenic halo•Mixed echopattern•Posterior shadow
62%69%
86%
BIRADS 3
“Lobulated mass, BI-RADS 3,” in a 40-year-old woman with a circumscribed left breast mass seen at mammography.
Oval, sharp, parallel, hypoFibro adenoma
©2010 by Radiological Society of North America
Hematoma in a 45-year-old woman with recent trauma to her right breast.
Raza S et al. Radiographics 2010;30:1199-1213
©2010 by Radiological Society of North America
Hematoma in a 45-year-old woman with recent trauma to her right breast.
Raza S et al. Radiographics 2010;30:1199-1213
©2010 by Radiological Society of North America
Hematoma in a 45-year-old woman with recent trauma to her right breast.
Raza S et al. Radiographics 2010;30:1199-1213
©2010 by Radiological Society of North America
BIRADS 4
Palpable mass in the left breast of a 70-year-old woman.
1st visit BIRADS 3
©2010 by Radiological Society of North America
IDC
2nd visit BIRADS 4: circumscribed, hypo, not parallel
©2010 by Radiological Society of North America
US image of a 50-year-old woman who presented with a palpable mass (arrows) in the right breast.
BIRADS 4: posterior border indistinctIDC
©2010 by Radiological Society of North America
BI-RADS 4A in a 55-year-old woman who presented with a palpable mass and swelling in her left breast.
Oval, hypo echoic, partial indistinct, posterior enhancement.Surgery: ruptured cyst
©2010 by Radiological Society of North America
BI-RADS 4B.
Parallel, hypo echoic, indistinct, mixed echopatternDCIS
©2010 by Radiological Society of North America
BIRADS 5
BI-RADS 5 in a 59-year-old woman with an irregular spiculated mass seen at mammography.
Indistinct, hypo, irregular / spiculated, not parallel, shadow,
©2010 by Radiological Society of North America
Technique
Importance of correlation in location between US and mammography.
Raza S et al. Radiographics 2010;30:1199-1213
©2010 by Radiological Society of North America
Importance of correlation in location between US and mammography.
Raza S et al. Radiographics 2010;30:1199-1213
©2010 by Radiological Society of North America
Clinical
27-year-old woman with a palpable right subareolar mass that was extremely tender to palpation, who also reported 2 days of fever.
Raza S et al. Radiographics 2010;30:1199-1213
©2010 by Radiological Society of North America
Abscess
BIRADS 4a:oval, partly indistinct border, complex echopattern, parallelAspirate
©2010 by Radiological Society of North America
Post traumatic fat necrosis.
BIRADS 3: oval, circumscribed, mixed, parallel, at trauma site
©2010 by Radiological Society of North America
Negative biopsy
• Technique• Correlation Histology / Radiology
– Repeat biopsy– Follow up 6m / 12m
Figure 8b. Confirmation of lesion penetration.
Youk J H et al. Radiographics 2007;27:79-94
©2007 by Radiological Society of North America
Figure 8c. Confirmation of lesion penetration.
Youk J H et al. Radiographics 2007;27:79-94
©2007 by Radiological Society of North America
Figure 10a. Appearance of the specimen in formalin.
Fat
©2007 by Radiological Society of North America
Figure 10b. Appearance of the specimen in formalin.
Tissue
©2007 by Radiological Society of North America
BIRADS 5: irregular, spiculated, hypo echoid with shadow
©2007 by Radiological Society of North America
Figure 13b. Radiologic-histologic discordance in a 41-year-old woman with invasive ductal carcinoma.
Youk J H et al. Radiographics 2007;27:79-94
©2007 by Radiological Society of North America
BenignMalignant
•Oval•Parallel to skin•Circumscribed
•Sharp boundary•Hyper echoic
•Irregular / round•Not parallel•Indistinct, angular, spiculated•Echogenic halo•Mixed echopattern•Posterior shadow
Other
Type 1 6%
Type 2
Type 3 >30%
t
%
MRI
Elastosonography
Fibroadenoma.
Smaller on Elastosono
©2009 by Radiological Society of North America
Invasive ductal carcinoma.
Carcinoma larger on Elastosono
©2009 by Radiological Society of North America
BenignMalignant
•Oval•Parallel to skin•Circumscribed
•Sharp boundary•Hyper echoic
•Irregular / round•Not parallel•Indistinct, angular, spiculated•Echogenic halo•Mixed echopattern•Posterior shadow