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BI-RADS Explained

djmammo Member Posts: 1,003
edited March 2022 in Not Diagnosed But Worried

from Cancer.Org

This is a nice explanation of the Birads scoring system: Click Here for the article.

When I first started reading mammograms in the early 80's there was really no official standard vocabulary for describing what was seen on a mammogram. Different readers would use different terms and it became confusing when 2 people read the same study, had the same recommendation but completely different verbiage in the body of the report. Birads was developed to standardize the conclusions of the reports so that no matter what the report said above the impression, the Birads would clear it all up. Over the years the system was improved by providing radiologists a list of acceptable terms to use in reports (the Birads Lexicon) so that all reports would be comparable and understood by all concerned.


  • Peacelady
    Peacelady Member Posts: 3
    edited April 2019

    I believe that my doctor said that I have a BI-RADS score of 3 based on my MRI in December. But keep seeing that BI-RADS are based on mammogram imaging. Is that true? My next recommended step is ultra sound

    I also have family history of Breast cancer in my family which is why I've been having MRI imaging

    Thank yo

  • josieo
    josieo Member Posts: 140
    edited April 2019


    Many thanks for sharing this resource. You consistently add so much to my understanding of breast cancer. So glad you are here. THANK YOU

  • djmammo
    djmammo Member Posts: 1,003
    edited April 2019


    All breast imaging studies use Birads.

  • Jerz_0035
    Jerz_0035 Member Posts: 3
    edited April 2019

    So I just got off of the phone with my doctor. I had a mammo and ultrasound a few weeks ago and was sent for an MRI. Mammo report says BIRADS 2. After the MRI being denied numerous times, we were finally able to get it pushed through. He just called and said that the skin thickening that was seen on all of the other scans was confirmed on the MRI and the radiologist saidcancer cannot be ruled out. There were no underlying masses seen. He’s having me scheduled for a biopsy. Any idea exactly what will be done? I have peau d’orange on the inner left breast and crusting of the nipple. The entire breast is extremely itchy!

  • DeeDeeT405
    DeeDeeT405 Member Posts: 27
    edited December 2019

    This may have been answered somewhere, but as I'm awaiting more testing and my appointment with the breast surgeon in 3 days I'm coming up with more questions. How do the radiologists determine the BIRADS score? Is there a point assigned for each finding and then the points are totaled to come up with the score of 0-6? I'm wondering, on a “suspicious" mammogram/ ultrasound study, what differentiates a score of 5 from 4? Thank you.

  • Member Posts: 1,434
    edited December 2019

    I'm sure djmammo will be by to explain this better, but until then, my understanding is that the BIRADs score is assigned by the Radiologist based in the appearance of the imaging. There is no points system however the BIRADs system provides clear and detailed guidelines as to what goes into each category. Of course since the assessment of the imaging is done by the Radiologist, there is a human element and some degree of subjectivity.

    Here are two sites that explain what's in each BIRADS category:

  • DeeDeeT405
    DeeDeeT405 Member Posts: 27
    edited December 2019

    Thank you Beesie those are very helpful.

  • thisiknow
    thisiknow Member Posts: 88
    edited December 2019

    The OP djmammo gave us the link at the top of this page at "Click here" for an explanation of Birads scoring.

  • DeeDeeT405
    DeeDeeT405 Member Posts: 27
    edited December 2019

    Thank you thisiknow. I had read that post but I only saw that the numbers correlated with the potential risk for malignancy. I was trying to determine what went into the assignment of the score. For example, my scans were given a BIRADS 5 and I was just wanting to know what distinguishes a 5 from a 4 on a scan. I understand they give the potential risk of malignancy at >95%. The articles that Beesie posted were very helpful. I don’t mean to waste anyone’s time, just trying to educate myself.

  • summerkeenan
    summerkeenan Member Posts: 1
    edited March 2022

    I’ve been assigned a BI-RADS Category 5 with acoustic shadowing and architectural distortion. I underwent biopsy last Wednesday and am still awaiting results. My radiologist has said if they are inconclusive, they will want to biopsy again. The mass is 10mmx10mm. Im highly concerned and this wait has been difficult. I understand it has a 95% or higher chance of being malignant. Given the other associated features, what are other things I should be prepared for in the next week? (Expecting hopefully conclusive results by next Wednesday at the latest)

  • krystinem
    krystinem Member Posts: 7
    edited March 2022

    Hi Summerkeenan

    I too was a birads5...was told 2 days later it was defintely cancer, then took about 2 weeks for pathology. I found out at that appointment that it was hormone postive and because of size, 21mm, I could have surgery next. Usually chemo first for larger tumours and inflammatory breast cancer. They removed lymphnodes during surgery. After that full pathology, I was told needed chemo and radiation.

    It's a very confusing time, and life seems to stand still while waiting. But for most of us, once you have more answers and treatment is put in place, things start to settle a bit.

  • moderators
    moderators Posts: 7,271
    edited March 2022

    Hi summerkeenan, and welcome to We know you're going through a scary and uncertain time, but just wanted to let you know that you are not alone! Read here for steps you can take to feel more in control of the process while you wait:

    In addition, there is a thread on Abbreviations to help you follow discussions going on in the community.

    Good luck!

    The Mods

  • salamandra
    salamandra Member Posts: 703
    edited March 2022

    Hi summerkeenan,

    After my biopsy came back malignant (also after a birads 5), I was able to send it to the cancer center near me that I wanted to be treated at. They only take confirmed cancer patients. They called me after they received it and set me up with an appointment with a surgical oncologist. Like krystinem, the size and hormones of my cancer meant surgery first. The surgical oncology appointment was the thing that finally let me start breathing again. My understanding coming away from it was that this was a diagnosis that would turn my life upside down but only for a time, and that I had a very good chance at a normal lifespan (as a teenager, I had watched my mother die of breast cancer - I was very scared).

    Still, there was a lot more waiting. Waiting for the surgical pathology, waiting for the oncotype, waiting to see my side effects from radiation and hormone treatment, etc. I would say that each stage of waiting was easier than the previous one. For me, the hardest time was between diagnosis and the first surgical oncology appointment (to be fair, I had no idea what my birads 5 meant and didn't get worried until the night before biopsy - for that one particular moment, ignorance was indeed bliss!)

    For now, probably you should figure out where you'd wanted to be treated in the event it is confirmed to be cancer, and what you have to do to set up your initial appointment there (not all centers will make you wait for the diagnosis). Everything else is mental/emotional/psychological at this point. Get your coping mechanisms ready, your mental health/emotional support on deck, and settle in the ride!

    Good luck! And remember that high likelihood of malignancy does NOT mean a higher stage or more dangerous form of cancer.