Breast imaging-reporting and data system (BI-RADS) assessment category 3

Last revised by Mohammadtaghi Niknejad on 7 Jun 2023

BI-RADS 3 is an intermediate category in the breast imaging reporting and data system. A finding placed in this category is considered probably benign, with a risk of malignancy of > 0% and ≤ 2%4.

BI-RADS 3 should not be utilized in the screening setting. It should be reserved for the diagnostic setting, such as when patients are recalled from screening for additional views (ie, following BI-RADS 0) or when patients present with a palpable lump.

The BI-RADS Atlas, fifth edition, contains three mammographic findings that should be categorized as BI-RADS 3 4,6:

The following sonographic findings may be categorized as BI-RADS 3 6:

  • complicated cyst with uniform low-level echoes
  • microlobulated or oval mass composed of clustered microcysts (although BI-RADS 2 may be appropriate if the appearance is classic 7)
  • hypoechoic mass, circumscribed, oval, parallel, without posterior features or with minimal posterior enhancement
  • hyperechoic mass with central hypoechoic to anechoic components and surrounding edema consistent with, but not diagnostic of, fat necrosis
  • refraction shadowing without an associated mass
  • architectural distortion thought to be due to postsurgical scar

BI-RADS 3 carries a management recommendation of short-term follow-up. The recommendation should be for the modality or modalities that best demonstrated the initial finding. While follow-up protocols differ across practices, a common schedule is at 6, 12, and 24 months. Once stability is documented for at least two, and at most three years, the finding can be downgraded to BI-RADS 2 (benign). If the finding develops suspicious features such as growth, non-circumscribed margins, or suspicious calcification morphology, then a BI-RADS 4 or BI-RADS 5 classification should be considered.

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Cases and figures

  • Case 1
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  • Case 2: mammography
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  • Case 2: ultrasonography
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