Recently, a patient came in with a mammogram film and asked, “Doctor, look at this, I’m at grade 2, is it all advanced! Does grade = stage? Of course not. The Breast Imaging Reporting and Data System (BI-RADS) proposed by the American College of Radiology plays a major role in standardizing mammogram reporting, reducing confusion in image depiction, and detecting census results. BI-RADS grading: Grade 0: other imaging tests are needed: ultrasound, MRI, local compression photography and magnification photography; Grade I: negative, no abnormal findings; Grade II: benign lesions are considered. Breast fibroadenoma,, multiple endocrine calcifications, fat-containing lesions (lipid cysts, lipomas, ductal cysts, and mixed-density mismatched tumors), intramammary lymph nodes, vascular calcifications, implants, and structural distortions with a history of surgery. No malignant x-ray conformation; Grade III: Probably benign and large, short-term follow-up is recommended. Lesions are confirmed by stabilization or reduction in size at short-term (less than 6 months) follow-up. Grade III (probably benign) is changed to grade II (benign) with a stable lesion at 2 or 3 years of follow-up; Grade IV: suspicious abnormality requiring biopsy for clarification. These lesions do not have characteristic morphological changes of breast cancer, but have the possibility of malignancy. It continues to be divided into IVA, IVB, and IVC subgrades; IVA: lesions that require biopsy but have a low likelihood of malignancy. If the biopsy or cytology is benign, routine follow-up is suspected or after six months; IVB: moderate malignancy is possible. Fibroadenoma or fat necrosis with partially defined borders and partially infiltrated mass puncture should be followed regularly. In case of punctured papilloma, further excisional biopsy is needed for further clarification. IVC: Malignant lesions are highly likely. Substantial masses with irregular morphology, infiltrated margins and clustered distribution of fine pleomorphic calcifications. Those diagnosed as grade IV on imaging should be followed up regularly with benign pathological findings, regardless of the subgrade. For imaging grade IVC, pathological puncture with benign findings should be further evaluated to clarify the diagnosis. Grade V: Highly suggestive of malignant possibility, the clinic should take appropriate measures, and the possibility of detecting malignancy is greater than 95%. Irregularly shaped, dense masses with stellate margins, rod-like, linear and bifurcated microcalcifications, irregular masses with polymorphic calcifications. Grade VI: A biopsy pathology has been performed to confirm the diagnosis of malignancy. However, cases with only limited prior treatment (surgical resection, radiotherapy, chemotherapy or mastectomy) or detection of imaging changes from neoadjuvant chemotherapy prior to surgery.