BIRAD D4?

DSBROOKS
DSBROOKS Member Posts: 2

Hi,

Can someone please help me understand BIRAD D4?

 

Comments

  • Megan M
    Megan M Member Posts: 3,000
    From what I could find,

    From what I could find, Bi-Rads stands for Breast Imaging Reporting and Data Systems. Breasts are staged by density and D4=extremely dense.

    Was this on one of your test reports or did your oncologist tell you this? 

    Megan

  • DSBROOKS
    DSBROOKS Member Posts: 2
    Megan M said:

    From what I could find,

    From what I could find, Bi-Rads stands for Breast Imaging Reporting and Data Systems. Breasts are staged by density and D4=extremely dense.

    Was this on one of your test reports or did your oncologist tell you this? 

    Megan

    Hi Megan
    Thank you. It was my

    Hi Megan

    Thank you. It was my mammogram test . I need to schedule a biopsy.

     

    Sally

  • jessiesmom1
    jessiesmom1 Member Posts: 915 Member
    BIRADS

    The BIRADS classification system indicates a radiologist's opinion on the presence or absence of breast cancer. It has nothing to do with breast density. BIRADS 4 = a diagnosis of suspicious malignancy. It is not characteristic of breast cancer but has a "reasonable probability" of being malignant (3-94%). A biopsy should be considered with this diagnosis.

    I am glad  you are following through. Good luck and keep us posted.

    IRENE

  • cinnamonsmile
    cinnamonsmile Member Posts: 1,187 Member
    I found a website that talks

    I found a website that talks about a BIRADS D4 diagnoses as the D4 indicating dense breasts (http://www.womenshealthsection.com/content/gyno/gyno018.php3)

    Currently, the most common clinical measure of density is the Breast Imaging Reporting and Data Systems (BI-RADS) density method, proposed by the American College of Radiology (3)(17). BI-RADS density is a subjective measure used by radiologists to classify a mammogram as follows:

    • D1: Fatty;
    • D2: Scattered density;
    • D3: Heterogeneously dense; or
    • D4: Extremely dense.

    Computer assisted methods are used to estimate quantitative measures of MBD, including percent density (percentage of the overall breast showing dense tissue; PD), absolute dense area, and non-dense area (3)(16).

  • Ritzy
    Ritzy Member Posts: 4,381 Member

    BIRADS

    The BIRADS classification system indicates a radiologist's opinion on the presence or absence of breast cancer. It has nothing to do with breast density. BIRADS 4 = a diagnosis of suspicious malignancy. It is not characteristic of breast cancer but has a "reasonable probability" of being malignant (3-94%). A biopsy should be considered with this diagnosis.

    I am glad  you are following through. Good luck and keep us posted.

    IRENE

    The 4 after the BiRads does

    The 4 after the BiRads does mean extremely dense, like Megan wrote.

    Sue :)

  • jessiesmom1
    jessiesmom1 Member Posts: 915 Member
    BI-RADS Category 4

    According to the American College of Radiology - BI-RADS-Mammography, 4th Edition:

    Category 4
    Suspicious Abnormality—Biopsy Should Be Considered:
    (See Guidance Chapter*):


    This category is reserved for findings that do not have the
    classic appearance of malignancy but have a wide range
    of probability of malignancy that is greater than those in
    Category 3. Thus, most recommendations of breast
    interventional procedures will be placed within this
    category. By subdividing Category 4 into 4A, 4B and 4C as
    suggested in the guidance chapter, it is encouraged that
    relevant probabilities for malignancy be indicated within
    this category so the patient and her physician can make
    an informed decision on the ultimate course of action.

    GUIDANCE CHAPTER

    Category 4:


    Category 4 is used for the vast majority of findings
    prompting breast interventional procedures
    ranging from aspiration of complicated cysts to
    biopsy of pleomorphic calcifications. Many institutions
    have, on an individual basis, subdivided
    Category 4 to account for the vast range of lesions
    subjected to interventional procedures and corresponding
    broad range of risk of malignancy. This
    allows a more meaningful practice audit, is useful
    in research involving receiver-operating characteristic
    (ROC) curve analysis, and is an aid for
    clinicians and pathologists. The optional division

    of Category 4 into three subdivisions internally
    at the facility level helps to accomplish these goals.


    Category 4A
    Category 4A may be used for a finding needing
    intervention but with a low suspicion for
    malignancy. A malignant pathology report not
    expected and a 6-month or routine follow-up
    after a benign biopsy or cytology is appropriate.
    Examples of findings placed in this
    category may be a palpable, partially circumscribed
    solid mass with ultrasound features
    suggestive of a fibroadenoma, a palpable
    complicated cyst or probable abscess.


    Category 4B
    Category 4B includes lesions with an intermediate
    suspicion of malignancy. Findings in
    this category warrant close radiologic and
    pathologic correlation. Follow-up with a
    benign result, in this situation, depends on
    concordance. A partially circumscribed, partially
    indistinctly marginated mass yielding
    fibroadenoma or fat necrosis is acceptable,
    but a result of papilloma might warrant
    excisional biopsy.


    Category 4C
    Category 4C includes findings of moderate
    concern, but not classic (as in Category 5)
    for malignancy. Examples of findings placed
    in this category are an ill-defined, irregular
    solid mass or a new cluster of fine pleomorphic
    calcifications. A malignant result in this
    category is expected.
    These internal divisions of Category 4 should
    encourage pathologists to initiate further
    evaluation of benign results in a Category 4C,
    and should allow clinicians to better understand
    follow-up recommendations after biopsy for findings placed in each subset of
    Category 4.

  • cinnamonsmile
    cinnamonsmile Member Posts: 1,187 Member

    BI-RADS Category 4

    According to the American College of Radiology - BI-RADS-Mammography, 4th Edition:

    Category 4
    Suspicious Abnormality—Biopsy Should Be Considered:
    (See Guidance Chapter*):


    This category is reserved for findings that do not have the
    classic appearance of malignancy but have a wide range
    of probability of malignancy that is greater than those in
    Category 3. Thus, most recommendations of breast
    interventional procedures will be placed within this
    category. By subdividing Category 4 into 4A, 4B and 4C as
    suggested in the guidance chapter, it is encouraged that
    relevant probabilities for malignancy be indicated within
    this category so the patient and her physician can make
    an informed decision on the ultimate course of action.

    GUIDANCE CHAPTER

    Category 4:


    Category 4 is used for the vast majority of findings
    prompting breast interventional procedures
    ranging from aspiration of complicated cysts to
    biopsy of pleomorphic calcifications. Many institutions
    have, on an individual basis, subdivided
    Category 4 to account for the vast range of lesions
    subjected to interventional procedures and corresponding
    broad range of risk of malignancy. This
    allows a more meaningful practice audit, is useful
    in research involving receiver-operating characteristic
    (ROC) curve analysis, and is an aid for
    clinicians and pathologists. The optional division

    of Category 4 into three subdivisions internally
    at the facility level helps to accomplish these goals.


    Category 4A
    Category 4A may be used for a finding needing
    intervention but with a low suspicion for
    malignancy. A malignant pathology report not
    expected and a 6-month or routine follow-up
    after a benign biopsy or cytology is appropriate.
    Examples of findings placed in this
    category may be a palpable, partially circumscribed
    solid mass with ultrasound features
    suggestive of a fibroadenoma, a palpable
    complicated cyst or probable abscess.


    Category 4B
    Category 4B includes lesions with an intermediate
    suspicion of malignancy. Findings in
    this category warrant close radiologic and
    pathologic correlation. Follow-up with a
    benign result, in this situation, depends on
    concordance. A partially circumscribed, partially
    indistinctly marginated mass yielding
    fibroadenoma or fat necrosis is acceptable,
    but a result of papilloma might warrant
    excisional biopsy.


    Category 4C
    Category 4C includes findings of moderate
    concern, but not classic (as in Category 5)
    for malignancy. Examples of findings placed
    in this category are an ill-defined, irregular
    solid mass or a new cluster of fine pleomorphic
    calcifications. A malignant result in this
    category is expected.
    These internal divisions of Category 4 should
    encourage pathologists to initiate further
    evaluation of benign results in a Category 4C,
    and should allow clinicians to better understand
    follow-up recommendations after biopsy for findings placed in each subset of
    Category 4.

    Jessiesmom1: It would appear

    Jessiemom1. It would appear that BIRADS looks for at least two things: abnormalities in the breast AND breast density. I am thinking that a D paired with a 4 means that the Density of the breast is at a level 4 meaning that the breast is extremely dense. I am assuming that there was also something suspicious found that indicates a need for a biopsy.

    http://www.cancer.org/treatment/understandingyourdiagnosis/examsandtestdescriptions/mammogramsandotherbreastimagingprocedures/mammograms-and-other-breast-imaging-procedures-mammo-report

    Mammograms and Other Breast Imaging Procedures

    +-Text Size

     



     


    TOPICS


    What is a mammogram?
    Types of mammograms
    How is a mammogram done?
    Help with mammogram costs
    Regulation of mammography
    What does the doctor look for on a mammogram?
    Breast biopsy
    Mammogram reports – BI-RADS
    Mammograms in special circumstances
    Improving mammograms
    Other breast imaging tests
    Experimental and other breast imaging methods
    To learn more
    References




     

    Previous Topic

    Breast biopsy




    Mammogram reports – BI-RADS

    The American College of Radiology (ACR) has developed a standard way of describing mammogram findings. In this system, the results are sorted into categories numbered 0 through 6. This system is called the Breast Imaging Reporting and Data System (BI-RADS). Having a standard way of reporting mammogram results lets doctors use the same words and terms and ensures better follow up of suspicious findings. Here’s a brief review of what the categories mean:

    X-ray assessment is incomplete

    Category 0: Additional imaging evaluation and/or comparison to prior mammograms is needed.

    This means a possible abnormality may not be clearly seen or defined and more tests are needed, such as the use of spot compression (applying compression to a smaller area when doing the mammogram), magnified views, special mammogram views, or ultrasound.

    This also suggests that the mammogram should be compared with older ones to see if there have been changes in the area over time.

    X-ray assessment is complete

    Category 1: Negative

    There’s no significant abnormality to report. The breasts look the same (they are symmetrical) with no masses (lumps), distorted structures, or suspicious calcifications. In this case, negative means nothing bad was found.

    Category 2: Benign (non-cancerous) finding

    This is also a negative mammogram result (there’s no sign of cancer), but the reporting doctor chooses to describe a finding known to be benign, such as benign calcifications, lymph nodes in the breast, or calcified fibroadenomas. This ensures that others who look at the mammogram will not misinterpret the benign finding as suspicious. This finding is recorded in the mammogram report to help when comparing to future mammograms.

    Category 3: Probably benign finding – Follow-up in a short time frame is suggested

    The findings in this category have a very good chance (greater than 98%) of being benign (not cancer). The findings are not expected to change over time. But since it’s not proven benign, it’s helpful to see if an area of concern does change over time.

    Follow-up with repeat imaging is usually done in 6 months and regularly thereafter until the finding is known to be stable (usually at least 2 years). This approach helps avoid unnecessary biopsies, but if the area does change over time, it allows for early diagnosis.

    Category 4: Suspicious abnormality – Biopsy should be considered

    Findings do not definitely look like cancer but could be cancer. The radiologist is concerned enough to recommend a biopsy. The findings in this category can have a wide range of suspicion levels. For this reason, some doctors may divide this category further:

    • finding with a low suspicion of being cancer
    • finding with an intermediate suspicion of being cancer
    • finding of moderate concern of being cancer, but not as high as Category 5

    Not all doctors use these subcategories.

    Category 5: Highly suggestive of malignancy – Appropriate action should be taken

    The findings look like cancer and have a high chance (at least 95%) of being cancer. Biopsy is very strongly recommended.

    Category 6: Known biopsy-proven malignancy – Appropriate action should be taken

    This category is only used for findings on a mammogram that have already been shown to be cancer by a previous biopsy. Mammograms may be used in this way to see how well the cancer is responding to treatment.

    BI-RADS reporting for breast density

    Mammogram reports can also include an assessment of breast density. BI-RADS classifies breast density into 4 groups:

    BI-RADS 1: The breast is almost entirely fat

    This means that fibrous and glandular tissue makes up less than 25% of the breast

    BI-RADS 2: There are scattered fibroglandular densities

    Fibrous and glandular tissue makes up from 25 to 50% of the breast.

    BI-RADS 3: The breast tissue is heterogeneously dense

    The breast has more areas of fibrous and glandular tissue (from 51 to 75%) that are found throughout the breast. This can make it hard to see small masses (cysts or tumors).

    BI-RADS 4: The breast tissue is extremely dense

    The breast is made up of more than 75% fibrous and glandular tissue. This can lead to missing some cancers.

    In some states, the summary of the mammogram report that is sent to patients (sometimes called the lay summary) must contain information about breast density. This information may be worded in lay language instead of the BIRADS categories. Women whose mammograms show BI-RADS 3 or 4 for breast density may be told that they have “dense breasts.”


  • Megan M
    Megan M Member Posts: 3,000

    Jessiesmom1: It would appear

    Jessiemom1. It would appear that BIRADS looks for at least two things: abnormalities in the breast AND breast density. I am thinking that a D paired with a 4 means that the Density of the breast is at a level 4 meaning that the breast is extremely dense. I am assuming that there was also something suspicious found that indicates a need for a biopsy.

    http://www.cancer.org/treatment/understandingyourdiagnosis/examsandtestdescriptions/mammogramsandotherbreastimagingprocedures/mammograms-and-other-breast-imaging-procedures-mammo-report

    Mammograms and Other Breast Imaging Procedures

    +-Text Size

     



     


    TOPICS


    What is a mammogram?
    Types of mammograms
    How is a mammogram done?
    Help with mammogram costs
    Regulation of mammography
    What does the doctor look for on a mammogram?
    Breast biopsy
    Mammogram reports – BI-RADS
    Mammograms in special circumstances
    Improving mammograms
    Other breast imaging tests
    Experimental and other breast imaging methods
    To learn more
    References




     

    Previous Topic

    Breast biopsy




    Mammogram reports – BI-RADS

    The American College of Radiology (ACR) has developed a standard way of describing mammogram findings. In this system, the results are sorted into categories numbered 0 through 6. This system is called the Breast Imaging Reporting and Data System (BI-RADS). Having a standard way of reporting mammogram results lets doctors use the same words and terms and ensures better follow up of suspicious findings. Here’s a brief review of what the categories mean:

    X-ray assessment is incomplete

    Category 0: Additional imaging evaluation and/or comparison to prior mammograms is needed.

    This means a possible abnormality may not be clearly seen or defined and more tests are needed, such as the use of spot compression (applying compression to a smaller area when doing the mammogram), magnified views, special mammogram views, or ultrasound.

    This also suggests that the mammogram should be compared with older ones to see if there have been changes in the area over time.

    X-ray assessment is complete

    Category 1: Negative

    There’s no significant abnormality to report. The breasts look the same (they are symmetrical) with no masses (lumps), distorted structures, or suspicious calcifications. In this case, negative means nothing bad was found.

    Category 2: Benign (non-cancerous) finding

    This is also a negative mammogram result (there’s no sign of cancer), but the reporting doctor chooses to describe a finding known to be benign, such as benign calcifications, lymph nodes in the breast, or calcified fibroadenomas. This ensures that others who look at the mammogram will not misinterpret the benign finding as suspicious. This finding is recorded in the mammogram report to help when comparing to future mammograms.

    Category 3: Probably benign finding – Follow-up in a short time frame is suggested

    The findings in this category have a very good chance (greater than 98%) of being benign (not cancer). The findings are not expected to change over time. But since it’s not proven benign, it’s helpful to see if an area of concern does change over time.

    Follow-up with repeat imaging is usually done in 6 months and regularly thereafter until the finding is known to be stable (usually at least 2 years). This approach helps avoid unnecessary biopsies, but if the area does change over time, it allows for early diagnosis.

    Category 4: Suspicious abnormality – Biopsy should be considered

    Findings do not definitely look like cancer but could be cancer. The radiologist is concerned enough to recommend a biopsy. The findings in this category can have a wide range of suspicion levels. For this reason, some doctors may divide this category further:

    • finding with a low suspicion of being cancer
    • finding with an intermediate suspicion of being cancer
    • finding of moderate concern of being cancer, but not as high as Category 5

    Not all doctors use these subcategories.

    Category 5: Highly suggestive of malignancy – Appropriate action should be taken

    The findings look like cancer and have a high chance (at least 95%) of being cancer. Biopsy is very strongly recommended.

    Category 6: Known biopsy-proven malignancy – Appropriate action should be taken

    This category is only used for findings on a mammogram that have already been shown to be cancer by a previous biopsy. Mammograms may be used in this way to see how well the cancer is responding to treatment.

    BI-RADS reporting for breast density

    Mammogram reports can also include an assessment of breast density. BI-RADS classifies breast density into 4 groups:

    BI-RADS 1: The breast is almost entirely fat

    This means that fibrous and glandular tissue makes up less than 25% of the breast

    BI-RADS 2: There are scattered fibroglandular densities

    Fibrous and glandular tissue makes up from 25 to 50% of the breast.

    BI-RADS 3: The breast tissue is heterogeneously dense

    The breast has more areas of fibrous and glandular tissue (from 51 to 75%) that are found throughout the breast. This can make it hard to see small masses (cysts or tumors).

    BI-RADS 4: The breast tissue is extremely dense

    The breast is made up of more than 75% fibrous and glandular tissue. This can lead to missing some cancers.

    In some states, the summary of the mammogram report that is sent to patients (sometimes called the lay summary) must contain information about breast density. This information may be worded in lay language instead of the BIRADS categories. Women whose mammograms show BI-RADS 3 or 4 for breast density may be told that they have “dense breasts.”


    Sally, did you schedule your

    Sally, did you schedule your biopsy yet?  Let us know when you do.

    Good luck, Megan

  • jenny57
    jenny57 Member Posts: 6
    What is BIRAD4?

    I don't know what BIRAD 4 is!