BI-RADS Grade 0 Ultrasonography cannot fully evaluate the lesion, and other imaging tests are needed for further diagnosis. Clinical signs, no signs on ultrasound Clinical signs on breast examination 1, clinically palpable lump or mass 2, nipple discharge without clinically palpable lump or mass 3, asymmetric thickening 4, skin and nipple changes ☆ Breast pain is a self-conscious symptom, and is not included in the clinical signs, according to the screening process of clinical signs BI-RADS level 1 Ultrasound does not show any abnormality, e.g., no lump, no structural disorder, no skin thickening, no microcalcification, etc. ★ Regularly review the examination every year (for polyglandular breasts, no sign on ultrasound). BI-RADS grade 2 benign signs, basically can exclude malignancy ① simple cyst ② intramammary lymph nodes (may also belong to grade 1) ③ breast prosthesis implantation ④ age <40 years old, consider fibroadenoma ⑤ fat lobules (pay attention to distinguish from fibroadenoma) ★ 6-12 months ultrasound regular review BI-RADS grade 3 Possible benign signs ① solid oval, well defined mass with aspect ratio <1 at age <40 years, benign possible, risk of malignancy <2% ② multiple complex cysts or clusters of small cysts ③ verrucous hyperplastic nodules (indeterminate) ★ Regular ultrasound examination at 3-6 months and other further investigations BI-RADS grade 3 l initial ultrasound examination at age 35-39 years For grade 3: *Family history *Patient anxiety *Reluctance to have regular checkups *Solid mass *Uncertain cystic solid mass *Cluster of small cysts ★Biopsy recommended Although multicenter data confirms that ultrasound is safe for short-term follow-up in this grade, it is increasing as a strategy or approach to management, and biopsy is needed in some people in this grade e.g., 35-39Y, ultrasound considers fibroadenoma as a possibility, patient is anxious and reluctant to have follow-up visits Biopsy BI-RADS grade 3 Evaluation after review Initial ultrasound of solid mass at age 35-39Y, no family history, ultrasound review at 3-6 months 1, mass shrinks and disappears → grade 2 2, mass remains unchanged and is reviewed again at 3-6 months and remains unchanged → grade 2 3, mass increases in size and changes toward malignant signs → grade 4 (biopsy) BI-RADS grade 4 Suspicious of abnormality Malignancy at this grade The risk of malignancy at this level is 3 to 94% ① Fibroadenoma and other benign lesions that do not meet all the ultrasound images (items 1-3 of the malignant manifestations in the benign and malignant differentiation table) ② Solid mass lesions with benign ultrasound signs at the age of 40 years or older, which may not have a characteristic breast cancer pattern but are of a high prevalence age with the likelihood of malignancy.4A ★ Suggested biopsies: Needle aspiration cytology, hollow-core needle aspiration biopsy, and surgical biopsy, etc. BI-RADS Grade 5 Highly probable malignant lesions. RADS grade 5 Highly probable malignancy Characteristic signs of abnormality on ultrasound (>3 signs of malignancy on the benign-malignant solid mass differential table), risk of malignancy >95% l Definitive therapy should be initiated. Sentinel lymph node imaging and neoadjuvant chemotherapy are considered when hollow-core needle aspiration biopsy is appropriate BI-RADS Grade 6 Biopsy-proven malignancy Used when the biopsy has confirmed malignancy, pre-treatment imaging evaluation Primarily to evaluate imaging changes after prior biopsy or to monitor imaging changes before surgical resection and before and after neoadjuvant chemotherapy