BI-RADS 3 Lesions: Diagnosis and Management

Definition and Diagnostic Criteria

• The American College of Radiology recommends that BI-RADS 3 lesions are probably benign with a malignancy probability of less than 2% 1, 2
• The National Comprehensive Cancer Network suggests that BI-RADS 3 lesions have a high confidence in benignity but not absolute certainty, requiring short-term follow-up instead of immediate biopsy 1, 2

Specific Lesions that Qualify as BI-RADS 3

• The National Comprehensive Cancer Network indicates that non-calcified circumscribed solid masses less than 2 cm without suspicious characteristics are considered BI-RADS 3 4
• Focal asymmetries that are not palpable and lack malignant characteristics are also classified as BI-RADS 3 4
• Rounded punctate calcifications in small groups are considered BI-RADS 3 2

Imaging Characteristics

• The American College of Radiology states that masses with well-defined contours, round or oval shape, and homogeneous density are characteristic of BI-RADS 3 lesions 2
• Calcifications with punctate morphology, grouped distribution, and no pleomorphism are also typical of BI-RADS 3 2

Follow-up Protocol

• The National Comprehensive Cancer Network recommends initial follow-up at 6 months with diagnostic unilateral mammography of the affected breast, followed by checks every 6-12 months for 1-2 years 1, 5
• At 6 months, diagnostic mammography or ultrasound of the affected breast is suggested 5, 3
• At 12 months, bilateral mammography in women ≥40 years is recommended to ensure annual evaluation of the contralateral breast 5, 3

Indications for Immediate Biopsy

• The National Comprehensive Cancer Network suggests that immediate biopsy is reasonable when follow-up is uncertain, the patient has significant anxiety, or there is a strong family history of breast cancer 1, 6, 3
• Biopsy is also indicated if the lesion increases in size or changes its benign characteristics during follow-up 1, 6

Management of Biopsy Results

• The National Comprehensive Cancer Network recommends that when biopsy is performed, there should be concordance between pathological and imaging findings 1, 6
• If there is discordance, the image and/or more tissue should be repeated through surgical excision 1, 6
• Benign concordant results require follow-up with mammography every 6-12 months for 1-2 years before returning to routine screening 6, 3