Amammography report is a key component of the breast cancer diagnostic process. Although mammographic findings were not clearly differentiated between benign and malignant lesion, the radiologist must assess the findings for chance of malignancy and guide the clinician for appropriate management. The report must be clear, concise and standardized for clinicians to understand.
For screening studies, the following questions need to be answered:
Assessment is incomplete
BI-RADS 0: Needs additional imaging evaluation and/or comparison to prior mammograms is needed.
Assessment is complete
BI-RADS 1: Negative
BI-RADS 2: Benign finding
BI-RADS 3: Probably benign findings-Short interval follow up
BI-RADS 4: Suspicious abnormality-Biopsy should be considered.
• 4A: finding with a low suspicious of being cancer, such as a palpable, partially circumscribed solid mass with ultrasound suspected fibro adenoma, a palpable complicated cyst and probable abscess
• 4B: intermediate suspicion of malignancy
• 4C: moderate suspicion, but no classic for malignancy
BI-RADS 5: Highly suggestive of malignancy- Appropriate action should be taken.
• A spiculated with irregular high-density mass
• A segmental or linear arrangement of fine linear calcification
• An irregular spiculated mass with pleomorphic microcalcification
BI-RADS 6: Known biopsy proven malignancy but prior to definite therapies such as surgical excision, radiotherapy, chemotherapy.
The format for mammography report should consist of:
1. Pertinent Information: Usually appears at the top of the report and typically includes the patient’s name, age and the reason for the mammogram (i.e., annual screening mammogram, referred by physician to evaluate new breast lump).
2. Clinical history: The patient’s medical and family history of breast cancer or other breast conditions. It may also include relevant medications the patient is taking, such as hormone replacement therapy.
3. Procedure: May explain what types of mammogram views were taken. Typical views for screening mammogram included the cranio-caudal view (CC) and the medio lateral oblique view (MLO). Typical views for diagnostic mammograms included CC, MLO and supplemental views tailored to the specific problem i.e., magnification views, spot compression and others.
4. Notation about comparison with previous studies.
5. A description of overall breast composition provided information about the accuracy of mammography for the breast being evaluated.
6. Significant findings and modifiers are described according to standardized terminology that has relevance in terms of potential for malignancy.
Findings that are of significance in patient management should be reported. Overall density is significant in that small cancers can be missed. The terms fibrocystic disease, fibrocystic changes, fibrocystic tissues, dysplasia, and hyperplasia are inappropriate and should be eliminated from image interpretation. Histopathologic terms should be reserved for the pathologist.5
Terminology section for described mammographic findings:
Round: punctate < 0.5 mm
Eggshell (< 1 mm in thickness): Fat necrosis, calcified cyst
Milk of calcium
Amorphous or indistinct Coarse heterogeneous
Fine linear branching
Distribution of breast calcifications
7. The report concludes with an overall assessment into a classification of the mammogram using the BI-RADS system developed by the American College Radiology (ACR).
8. Recommendation: Radiologists should give specific instructions on what actions should be taken next. For example, no action necessary, a six month follow-up mammogram, spot views, breast ultrasound, biopsy. etc.
9. Disclaimer: Radiologists should use disclaimer to communicate with clinician about the limitation of mammography and the meaning of a normal report.
The use of mammographic screening to detect cancer at a preclinical stage is increasing rapidly. High quality imaging and accurate interpretation are critical elements for successful mortality reduction. The communication of the interpretation is being scrutinized in an effort to eliminate ambiguity and confusion. This can be accomplished by an organized approach to interpretation and a structure analysis of significant findings. These can grouped into BI-RADS by ACR to suggest a probability of malignancy.8