The typical follow-up protocol for all modalities is similar. This paper will discuss the appropriate use of BI-RADS 3 with 3 core principles: (1) if a lesion is indeterminate or has worrisome features it is not BI-RADS 3 (2) BI-RADS 3 should not be used to delay diagnosis of a malignant appearing finding (3) BI-RADS 3 should only be used after a full diagnostic workup. Radiologists who are not sure what to do with a finding often overuse BI-RADS 3. It causes patient anxiety, eliminates some unneeded biopsies, and is often ignored by patients and referring clinicians. BI-RADS 3 creates a wide variety of actions and reactions. BI-RADS 3 lurks, however, in the middle and has significantly different meanings for mammography, ultrasound, and MRI and indeed is audited differently for the three modalities. BI-RADS 1 and 2-normal and benign-as well as BI-RADS 4 and 5-suspicious or highly suspicious-are relatively straightforward. Ortiz-Perez has shown that formal instruction in the ultrasound BI-RADS lexicon improves the characterization of findings and BI-RADS assessments. have shown that there is considerable interobserver variability in the assessments of mammographic Bi-RADS 3 findings and Grimm et al. īI-RADS 3 is perhaps the most difficult of the assessment categories for the breast imager to properly use. In practice, 0.9–7.9% of probably benign mammographic findings are upgraded to suspicious and proceed to biopsy. Designating a finding as probably benign in mammography is meant to indicate that the finding has a 2% or less chance of malignancy. Probably benign (BI-RADS 3) has been formally established as a unique assessment category in the BI-RADS Atlas. The purpose of the short-term follow-up algorithm is to reduce false-positive findings while retaining a high sensitivity for early stage breast cancer. Efforts to improve the specificity and cost-effectiveness of screening mammography led to the development and widespread acceptance of short-term follow-up of probably benign findings.
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