GYN

CMECNE

BI-RADS: Standardizing Breast Imaging and Reporting

Learning Objectives and CME/Disclosure Information

This activity is intended for healthcare providers delivering care to women and their families.

After completing this activity, the participant should be better able to:

1. List the elements in a standard mammogram report
2. Recall the BI-RADs categories that require a tissue diagnosis

Estimated time to complete activity: 0.25 hours

Faculty:

Susan J. Gross, MD, FRCSC, FACOG, FACMG President and CEO, The ObG Project

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.

The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.

Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.

Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.

Method of Participation and Request for Credit

Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Jan 25 2023, participants must read the learning objectives and faculty disclosures and study the educational activity.

If you wish to receive acknowledgment for completing this activity, please complete the test and evaluation. Upon registering and successfully completing the test with a score of 100% and the activity evaluation, your certificate will be made available immediately.

For Pharmacists: Upon successfully completing the test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education

Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.

Read Disclaimer & Fine Print

WHAT IS IT?

BI-RADS: Breast Imaging Reporting and Data System, was developed by the American College of Radiology (ACR) to standardize mammogram reporting, as well as breast ultrasound and MRI reporting.

The standard mammogram report includes the following

Indication and type of mammogram (screening/diagnostic)
Statement regarding breast density
Description of pertinent findings including size and location, oriented by quadrant and clock position
Summary of important findings and BI-RADS category

KEY POINTS:

BI-RADS Classification Standardizes Findings and Recommendations for Further Management

BI-RADS 0 : Incomplete

Recall for additional imaging/comparison with prior examinations, or both

BI-RADS 1: Negative (Essentially 0% chance of malignancy)

Routine screening

BI-RADS 2: Benign (Essentially 0% likelihood of malignancy)

Routine screening

BI-RADS 3: Probably benign (> 0% but ≤ 2% likelihood of malignancy)

6 month follow-up or continued surveillance

BI-RADS 4: Suspicious (> 2% but < 95% likelihood of malignancy)

4A: Low suspicion for malignancy (> 2% to ≤ 10% likelihood)
4B: Moderate suspicion for malignancy (> 10% to ≤ 50% likelihood)
4C: High suspicion for malignancy (> 50% to < 95% likelihood)
Tissue diagnosis needed for all BI-RADS 4 categories

BI-RADS 5: Highly suggestive of malignancy (95% likelihood of malignancy)

Tissue diagnosis needed

BI-RADS 6: Known, biopsy proven malignancy

Surgical excision when appropriate

Density Categories

Category a: Breasts are almost entirely fatty
- Prevalence: 10% of the population
- Mammography considered highly sensitive in this setting (88%)
Category b: There are scattered areas of fibroglandular density
- Prevalence: 43% of the population
- Still sensitive but decreased from category a (82%)
Category c: Breasts are heterogeneously dense
- Prevalence: 39%
- Small masses may be obscured
- Sensitivity drops to 69%
- Note: Breast cancer risk is 1.2 relative risk compared to average breast density
Category d: Breasts are extremely dense
- Breasts are extremely dense
- Significantly lowers sensitivity of mammography (62%)
- Note: Breast cancer risk is 2.1 relative risk compared to average breast density

Learn More – Primary Sources:

ACOG Practice Bulletin No 164. Diagnosis and Management of Benign Breast Disorders

ACR BI-RADS® Atlas, Breast Imaging Reporting and Data System

ACOG Committee Opinion 625: Management of with Dense Breasts Diagnosed with Mammography

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