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Common Breast Imaging Terminology and Findings

The terminology used in breast imaging can be somewhat confusing and possibly a cause for concern if the meaning isn’t readily clear. So Women First wants you to know the categories used to define results of breast imaging, be familiar with the most common imaging findings, and understand the breast diagnostic procedures that may be used to follow up after a mammogram.

BI-RADS Categories for Breast Images

There are 6 categories that are used for reporting and tracking breast imaging reports.

Category 0: Mammography Incomplete. Need additional imaging evaluation and/or prior mammograms for comparison

Category 1: Negative

Category 2: Benign (but other comments may be present)

Category 3: Probably Benign (usually follow up needed)
While the BI-RADS category 3 can be confusing, this category uses standardized terminology based on science demonstrating that follow-up (usually 3 to 6 months) rather than a biopsy is a safe and effective management plan for imaging findings that are very likely benign.

Category 4: Suspicious

  • Category 4A: Low suspicion for malignancy
  • Category 4B: Moderate suspicion for malignancy
  • Category 4C: High suspicion for malignancy

Category 5: Highly Suggestive of Malignancy

Category 6: Known Biopsy-Proven Malignancy

Common Breast Imaging Findings

Breast Cysts

Our breasts have fluid filled systems that can become congested at times; this fluid may collect and become visible on breast images.

  • Breast cysts can be described as “simple” or “complicated.”
  • A “simple” cyst is filled with watery-like fluid. These are generally a benign finding and, on occasion, can be aspirated (drained) for a patient’s comfort, or if they are very large.
  • “Complicated” cysts have a different appearance on ultrasound; they appear to have debris floating within them. This could be caused by the cyst being older and the fluid has become thicker—like syrup, or the cyst may have a solid component to it.

Focal Asymmetry

This is not a mass or a nodule. Focal asymmetry is a description of an area of tissue that looks a bit different within the breast itself, possibly a more dense area. This usually proves to be a normal change. Our breasts begin as dense tissue, and as we age, and/or have children and/or gain a little weight, our breast tissue becomes more fatty. The islands of breast tissue may appear differently because of the more fatty tissue surrounding it, or due to other changes such as weight gain or loss, more or less caffeine use, or hormonal changes.

Mass

A mass is a nodular finding on the breast image. It may be solid, fatty, or fluid-filled. Additional images are generally needed to determine exactly what this is and/or if further tests are needed.

Architectural Distortion

The breast tissue in an architectural distortion appears different than expected. This could be scar tissue or due to other changes such as weight gain or loss, caffeine use, or hormonal changes.

Additional Procedures for Breast Diagnostics

Cyst Aspiration:

Cyst aspiration is done under local anesthesia with ultrasound for guidance. The radiologist will numb the area and, using ultrasound for guidance, insert a small needle into the cyst to drain it. The fluid is sent to pathology if it is bloody, brown, or green. If the fluid is clear or straw colored, it is usually discarded.

Ultrasound Guided Biopsy:

Done under local anesthesia with ultrasound for guidance, the radiologist will numb the area and insert a needle into the area of concern, using ultrasound to direct these efforts. The needle has suction attached to it to make the process easier. The extracted tissue samples will be sent to pathology and the radiologist or healthcare provider will contact the patient with the results.

Stereotactic Biopsy:

For this type of biopsy, the patient is positioned with her breast through an opening in the machine. The breast is compressed, as with a mammogram machine, and a series of pictures is taken to determine exactly how deep the area of concern is in the breast. Next, a local anesthesia is injected and a small (1/8 inch) incision is made. A needle is inserted to biopsy the tissue, and several tissue samples may be taken. A biopsy clip will be placed at the biopsy site. A post-procedure mammogram will usually be obtained. The tissue samples are sent to pathology and the radiologist or healthcare provider will contact the patient with the results.

Excisional Biopsy:

This type of biopsy is performed by a breast surgeon. The patient is taken to the operating room and put under a heavier sedation. Generally, a needle is placed in the area of concern prior to the biopsy to guide the surgeon to the exact point. The tissue to be biopsied will be removed and sutures placed. The tissue will be sent to pathology, and the breast surgeon will contact the patient with the results.

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