Follow-up 6 Months After BI-RADS 3 Findings on Mammography Recommended for Women

A 6-month follow-up examination was recommended for women with mammographically detected breast lesions that are probably benign due to the small risk factor that the lesions are malignant, according to a study published in Radiology.

The Breast Imaging and Reporting System (BI-RADS) enabled researchers to closely examine the BI-RADS 3 category, who found that the malignancy rates in the BI-RADS 3 group significantly exceeded rates for women downgraded to the BI-RADS 1 and 2 groups.

“I thought that we should really look at this again now that we’ve got this large database we can work with and try to find out what happened with these patients,” study lead author Wendie A. Berg, MD, PhD, said in a press release.

Of the total population of women given BI-RADS 3 assessment after screening mammography recall, 810 (1.9%) were diagnosed with cancer. More, almost a third of women analyzed had an early-stage, noninvasive form of breast cancer known as ductal carcinoma in situ.

Of the 43,628 women given BI-RADS 3 assessment, 12% of invasive cancers diagnosed within 6 months with node staging had spread to the lymph nodes at follow-up.

The group of researchers assessed outcomes from 6-, 12- and 24-month follow-ups of the previously identified probably benign finding identified on recall from screening mammography in the National Mammography Database. The population was composed of women recalled from screening mammography with BI-RADS 3 assessment over a 10-year period.

“The majority of cancers were diagnosed at or right after the six-month follow-up, so it actually is important to get these patients back in that six-month time frame,” Berg said in a press release.

The BI-RADS classification system was established by the American College of Radiology, classifying the risk of breast cancer from a benign lesion (BI-RADS 2) to a biopsy-proven malignant lesion (BI-RADS 6).

The probably benign classification, BI-RADS 3, is a challenging categorization that often causes confusion for physicians and anxiety for patients. This classification means the lesion is one of a few specific findings that have shown “to have less than a 2% chance of being cancer and that any cancer present is not likely to spread in the time frame recommended for follow-up imaging.”

Much of the research determining that follow-ups for BI-RADS 3 lesions could be pushed back safely from 6 months to a year was done before the emergence of the National Mammography Database, resulting in a point of contention amongst professionals in the breast imaging community.

“The important thing about this paper is that these data come from a wide number of facilities across the United States, so it really brings to bear that, yes, this is the appropriate practice and yes, you still need to see these patients in six months,” Berg said in a press release.

Reference:

Six-month Follow-up Appropriate for BI-RADS 3 Findings on Mammography [news release]. Oak Brook, Illinois. Published May 19, 2020. http://press.rsna.org/timssnet/media/pressreleases/14_pr_target.cfm?ID=2182. Accessed May 22, 2020.