Many patients often have some unnecessary anxiety because they cannot properly understand the ultrasound report and mistakenly believe that their condition is serious. The following are some interpretations of the grading in breast ultrasound reports, which we hope will be helpful to you.
The terminology of ultrasound description of lesion characteristics should have a unified standardized standard. The terminology of ultrasound description needs to reflect the impact on the judgment and grading of the benignity and malignancy of the lesion, and the comprehensive analysis of multiple characteristic indicators. With the development of ultrasound technology, the connotation of the corresponding terminology will also change. The grading criteria refer to the BI-RADS of the American College of Radiology and combine with the actual situation in China to develop the following grading criteria.
(1) The assessment is incomplete. Usually rarely seen in ultrasound reports.
Grade 0.
Further evaluation by other imaging examinations (such as mammography or MRI) is needed.
(2) Assessment is complete – final grading.
Grade 1: Negative.
No positive clinical signs and no abnormalities on ultrasound imaging, e.g., no masses, no structural distortions, no skin thickening and no microcalcifications. To make the negative conclusion more credible, the ultrasound examination site should correspond as much as possible to the area of breast tissue of interest on the combined mammogram.
Grade 2: Benign lesions.
Basically, malignant lesions can be excluded. It can be followed up for 6 to 12 months depending on age and clinical presentation. For example, simple cysts, breast prostheses, lipomas, intramammary lymph nodes (which can also be classified as grade 1), postoperative changes in benign lesions with no change in images on multiple reexaminations, and nodules with documented little change in images after multiple examinations may be fibroadenomas.
Grade 3: Possible benign lesions.
Short-term review (3-6 months) and other further investigations are recommended, and surgical treatment is required.
According to the clinical experience accumulated from mammography, a lesion with clear typical benign ultrasound features (solid oval, clear border, unsaturated lump) found by ultrasound is very likely to be a fibroadenoma of the breast, which should have less than 2% risk of malignancy.
Grade 4: suspicious malignant lesions.
This grade of lesion has a malignant risk of 3% to 94%. Assessment of grade 4 means that histopathological examination is recommended: fine needle aspiration cytology, hollow core needle aspiration biopsy, surgical biopsy to provide a cytological or histopathological diagnosis. Ultrasonographic presentation not fully consistent with benign lesions or with malignant features are classified at this level.
Grade 5: Highly likely to be malignant and appropriate diagnosis and management should be actively taken.
A lesion with significant malignant features on ultrasonography is classified as this grade, with a risk of malignancy greater than 95%, and should be started with aggressive treatment, either by percutaneous biopsy (usually image-guided hollow-core needle aspiration biopsy) or surgery.
Grade 6: Has been biopsy confirmed as malignant.
The main focus is to evaluate imaging changes after prior biopsy or to monitor imaging changes before and after surgery and before and after neoadjuvant chemotherapy.
The above knowledge can provide some reference for the majority of patients, but the actual situation will be different due to the quality of ultrasound instruments in each hospital and the technical level of ultrasonographers, and needs to be combined with the judgment of clinicians.