BI-RADS Category 3 Mammographic Lesions

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after March 18, 2024:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Breast Sonography: 0.50
Patient Care: 0.50
Patient Interactions and Management: 0.50

Mammography: 1.50
Image Production: 0.25
Image Acquisition and Quality Assurance: 0.25
Procedures: 1.25
Anatomy, Physiology, and Pathology: 1.25

Registered Radiologist Assistant: 1.75
Safety: 0.75
Patient Safety, Radiation Protection, and Equipment Operation: 0.75
Procedures: 1.00
Thoracic Section: 1.00

Outline

1. Introduction
2. Change Weighed against Benign Morphology
   1. Masses
   2. Calcifications
   3. Focal Assymetries
3. Challenging Clinical Scenarios
   1. One-View Findings
   2. Postoperative Breast
4. Quality Control and Technical Parameters
5. Errors in Management and Assessment
6. Interobserver Variability
7. Conclusion

Objectives

Upon completion of this course, students will:

1. comprehend what BI-RADS category 3 means
2. understand the goals of implementing the BI-RADS category 3 classification
3. realize the likelihood of malignancy of a BI-RADS category 3 lesion
4. recognize the type of breast imaging that should be completed before assigning the BI-RADS category 3 classification
5. understand which mammographic findings are suitable for short-term follow-up
6. realize under what alternate condition radiologists can assign a probably benign classification
7. know the possible outcomes following a month waiting period after identifying an entity as fat necrosis
8. recognize the appearance of hematomas at mammography and ultrasound
9. know the BI-RADS fifth edition recommendation for follow-up waiting time to reassess a suspected breast hematoma
10. understand the course of action if a benign-appearing solid mass demonstrates growth
11. list benign calcifications that have classically benign features
12. recognize what finding would prompt biopsy at follow-up imaging for calcifications
13. define focal asymmetries
14. understand the meaning of developing asymmetries
15. realize the probability of malignancy when developing asymmetries are identified
16. know another term that means one-view finding
17. discuss the positive predictive value associated with one-view findings
18. describe changes seen at mammography following an excision of a benign breast lesion
19. identify changes seen at mammography following lumpectomy and radiation therapy
20. differentiate architectural distortion from tumor recurrence
21. learn about the technical differences from mammography exams that make it difficult to compare microcalcifications
22. understand that motion blur found on mammography exams with microcalcifications often prompts incorrect BI-RADS category 3 classification
23. know that in order to draw a conclusion about the stability of a lesion it must also be seen on a prior study
24. state the sensitivity for the detection of cancer with screening mammography on the augmented and nonaugmented breast
25. list common reasons for incomplete assessment that may result in improper use of the BI-RADS category 3 classification
26. recognize the proper BI-RADS assessment when a suspicious mammographic finding is followed by a negative ultrasound
27. recall study findings on the percent of BI-RADS category 3 lesions that actually met the morphologic criteria to be considered probably benign lesions
28. realize that varying nomenclature can be the cause of interobserver variability
29. understand what radiologists should do to reduce interobserver variability
30. know that an initial assessment of probable benignity should not bias the subsequent radiologist’s assessment