Breast Imaging
Core concepts
Understand breast anatomy and the BI-RADS lexicon: mass, calcification, asymmetry, and architectural distortion, with final assessment categories 0–6 and their management implications. Learn mammographic technique and the value of additional views (magnification, spot compression, true lateral). Understand the imaging features of benign versus malignant calcifications (coarse, popcorn, rim versus pleomorphic, linear, branching). Know the role of breast ultrasound (solid versus cystic, guidance for biopsy) and breast MRI (high-risk screening, extent of disease, implant evaluation). Understand the principles of screening: age, interval, and the balance of overdiagnosis. Learn the staging of breast cancer and the significance of axillary nodes.
Traps
BI-RADS 3 is probably benign with short-interval follow-up, not biopsy. Do not dismiss architectural distortion - it may be the only sign of malignancy. Microcalcifications are best assessed on magnification views. A negative mammogram in a dense breast does not exclude cancer; ultrasound or MRI may be needed. Remember that MRI has high sensitivity but lower specificity.
Rule of thumb
Apply BI-RADS categories strictly: 0 needs additional imaging, 1–2 are negative/benign, 3 is probably benign with follow-up, 4 is suspicious (biopsy), 5 is highly suggestive of malignancy, 6 is known biopsy-proven malignancy.