Mammogram grading (based on BI-RADS grading scale)
Grade 0: Needs further evaluation or comparison with previous findings in conjunction with other imaging studies.
☆ Grade 1: Negative with no abnormal findings. Bilateral breast symmetry with no masses, structural distortions or suspicious calcifications.
☆ Grade 2: benign findings. Negative mammogram findings, the report may describe some changes but overall there are no radiographic signs of malignancy.
☆ Grade 3: Probably benign finding with short-term follow-up recommended. There is a high probability of benignity and the radiologist expects the lesion to stabilize or shrink during a short follow-up period (usually 6 months) to confirm his judgment. The malignancy rate at this level is generally less than 2%. For the management of this level, a follow-up of 6 to 12 months or ≥ 2 years is recommended. Evaluation of clinically palpable masses with this grade is inappropriate; biopsy should be recommended rather than continued follow-up for lesions that may be benign but appear to increase in size during follow-up.
☆ Grade 4: Suspicious abnormality to be considered for biopsy. This level includes a large group of lesions that require clinical intervention. These lesions do not have characteristic morphologic changes of breast cancer, but have malignant potential and are classified into subgrades 4A, 4B, and 4C.
4A: Includes a group of lesions that require biopsy but have a low probability of malignancy. The results of biopsy or cytologic examination are more credible for benign findings and are routinely followed up.
4B: Moderate malignancy potential. The perception of the credibility of the puncture biopsy findings in this group of lesions depends on consensus between the radiologist and the pathologist.
4C: A group of lesions that are further suspected to be malignant but have not yet reached grade 5. Substantial masses with irregular morphology and infiltrated margins and clusters of small polymorphic calcifications can be classified in this subgrade.
Lesions interpreted as grade 4 on imaging, regardless of subgrade, should be followed up regularly after benign pathologic findings. In contrast, for those with imaging suggestive of grade 4C and benign pathological puncture results, the pathological findings should be re-evaluated further to clarify the diagnosis.
☆ Grade 5: Highly suspicious of malignancy. This category of lesions has a high likelihood of malignancy, with a probability of detecting malignancy ≥ 95%. Appropriate clinical measures should be taken.
☆ Level 6: Confirmation of malignant lesions.
Grading of ultrasonographic findings
☆ Grade 0: Other examination methods are needed to assist in the evaluation, such as giant breast, nipple overflow ultrasound without abnormalities, etc.
☆ Grade 1: No abnormal findings.
☆ Grade 2: benign findings without malignant signs, such as cysts, and follow-up is recommended based on age and clinical findings.
☆ Grade 3: benign possibility, low possibility of malignancy, such as fibroadenoma, short-term follow-up is recommended.
Grade 4: Malignancy is not excluded, and puncture is recommended.
☆ Grade 5: Highly suspicious of malignancy, ultrasound image shows malignancy, biopsy is recommended.
Grade 6: Malignant lesion is confirmed.
Breast surgery clinical examination rating standards
Grade 0: No abnormal local signs in the breast, but suspicious cancer metastasis in the regional lymph nodes.
Grade 1: Normal breast.
Grade 2: Benign breast disorders.
☆ Grade 3: Benign breast lesion is likely to be large, but malignant (<25%) should be excluded.
☆ Grade 4: Suspected cancer, with a clinical judgment of malignancy of 25% to 50%.
Grade 5: Highly suspicious of cancer.
☆ Grade 6: confirmed malignant lesion.
Cytological diagnosis classification
☆ Grade 0: Unsatisfactory sample.
☆ Grade 1: Benign cells.
Grade 2: actively proliferating cells.
☆ Grade 3: More obvious heterogeneous proliferating cells, malignancy cannot be completely excluded.
☆ Grade 4: suspicious cancer cells and highly suspicious cancer cells.
☆ Grade 5: cancer cells. 5A: cancer cells, but must be confirmed by frozen histological diagnosis at the time of surgery; 5B: a large number of typical cancer cells, which can be directly performed radical surgery.
Grading of diagnostic report of coarse needle core biopsy (modified from the UK Health Screening Project)
☆ Grade 0: Insufficient specimen or unsatisfactory specimen, not diagnostic, need to retake or re-cut.
Grade 1: Normal breast tissue with no obvious pathological changes.
☆ Grade 2: Benign lesions including fibroadenoma, general type benign hyperplasia (especially common type intra-ductal epithelial hyperplasia lesions), sclerosing adenopathy, certain ductal papillary lesions, inflammatory changes, etc. Local excision or clinical follow-up is feasible.
☆ Grade 3: Lesions of undetermined malignant potential (benign possibility, but malignancy cannot be completely excluded). It is indicated for the following lesions: sclerosing ductal lesions (including radiolucent scars), certain hyperplastic intraductal papillomatosis, and ductal and lobular atypical hyperplasia (mild and moderate), usually requiring local excision.
Grade ☆ 4: Suspicious malignancy ( lesions that are only suggestive, but not fully diagnostic of malignancy), including material that is inadequate to determine malignancy, atypical lesions, or due to artifactual alterations in the production. Severe atypical hyperplasia of the catheter and lobules should be included here. Biopsy or local excision is required.
☆ Grade 5: Malignant, for lesions of definite malignancy.
5A: Carcinoma in situ. Definite intraductal carcinoma and lobular carcinoma in situ, including “suspected infiltrating” and microinfiltrating carcinoma, requiring local extended excision.
5B: definite invasive carcinoma, sarcoma, lymphoma and other malignant tumors, which should be treated accordingly. The surgical specimen can be tested for tumor staging, grading, pathological stage and immunohistochemical index.