What should you know?
BI-RADS is the American College of Radiology system for standardized mammography, ultrasound and breast MRI reporting. The final category communicates the assessment and recommended next step; it is not a cancer stage.
Category 0 is incomplete; 1 is negative; 2 is benign; 3 is probably benign with short-interval follow-up; 4 is suspicious and biopsy is considered; 5 is highly suggestive of malignancy; 6 is known biopsy-proven malignancy.
Common symptoms and signs
- BI-RADS is not a cancer stage
- Read the category together with the recommendation
- Category 3 generally means imaging surveillance
- Category 4 has subcategories and often leads to tissue diagnosis
Diagnosis and the role of ultrasound
The final category is based on standardized features and comparison with prior studies. Different modalities provide complementary information and may receive modality-specific assessments.
- Whether the evaluation is complete
- Routine screening versus short follow-up
- Whether biopsy is recommended
- Correlation with a palpable finding
Ultrasound findings must be interpreted together with symptoms, examination and, when needed, laboratory or other imaging results. An image alone should not be used for self-diagnosis or self-treatment.
Treatment and next steps
Follow the written recommendation: complete additional imaging for category 0, routine care for 1–2, scheduled follow-up for 3 and prompt biopsy discussion for 4–5. Category 6 is managed as a confirmed diagnosis.
Management is individual and depends on age, symptoms, imaging findings, other health conditions and pregnancy plans. Medication or a procedure should be selected with the appropriate clinician.
When is urgent care needed?
- Do not delay follow-up for BI-RADS 4 or 5
- Seek review for a rapidly growing lump despite a prior result
- Promptly assess new nipple retraction, bloody discharge or skin tethering
Related reading
- Breast lump — when do you need ultrasound or mammography?
- Breast ultrasound
- Enlarged lymph nodes — causes and diagnosis
When should you consult radiologist Lana Ezieshvili?
Radiologist Lana Ezieshvili performs targeted ultrasound examinations, describes findings using standard imaging criteria and explains the report in clear language.
If you have symptoms, a referral or need follow-up imaging, use the form below to book a visit with Lana Ezieshvili. Timely, appropriately selected imaging can reduce uncertainty and help determine the right next step.
This article is for education and does not replace medical advice. Seek urgent care for severe or rapidly worsening symptoms.