![]() ![]() Global asymmetry, in the absence of palpable correlate, is assessed BI-RADS 2 (benign). An exception would be if there is a clear benign explanation, such as recent surgery, trauma, or infection at that site. The BI-RADS Atlas offers guidance regarding the other categories of asymmetries 5:Ī solitary focal asymmetry (without architectural distortion, calcifications, or underlying mass identified on diagnostic mammography and ultrasound) is assessed as BI-RADS 3 (likely benign).Ī developing asymmetry, unless shown to be characteristically benign such as a cyst on ultrasound, is assessed BI-RADS 4 (suspicious). Radiology reportĪsymmetries that turn out to be summation artifact are benign ( BI-RADS 2). In the diagnostic setting, localized findings can be further evaluated by ultrasound. spot magnification views: rarely helpful for asymmetries alone but useful for evaluation of associated microcalcifications.90 degree lateral view/ LM view: useful to localize a finding better seen on MLO projection.rolled CC view: useful to localize a finding only seen on CC view.spot compression views: useful to distinguish superimposition of tissues from real findings (summation shadows disappear upon compression).When sonography demonstrates echogenic tissue. (B) Spot compression images demonstrating the mass to better advantage. Upon recall from screening mammography, repeating the original view(s) with the finding is often helpful and additional views should be considered: Sonographic evaluation of a focal asymmetric density is helpful, particularly to identify an underlying mass. (A) Right craniocaudal and mediolateral oblique views, showing a focal asymmetry in the deep upper outer breast (arrow), which was stable for 10 years and classified as glandular asymmetry by the interpreting radiologist. Otherwise, findings of an asymmetry, focal asymmetry, or developing asymmetry found on screening merit recall for further evaluation. global asymmetry: visible on two projections, involves more than one quadrantĪn asymmetry or focal asymmetry that is unchanged over at least 2 years does not deserve attention.developing asymmetry: focal asymmetry that is new, larger, or more conspicuous than on prior examinations.focal asymmetry: visible on two projections, involves less than one quadrant, lacks convex-outwards borders or is interspersed with fat.asymmetry: visible on only one projection.The BI-RADS lexicon defines four types of asymmetries 5: Global asymmetry is most commonly a normal variant and is discussed separately. Developing asymmetries are sufficiently suspicious to justify recall and biopsy, with 15% representing malignancy 7. Breast Imaging Reporting and Data System (BI-RADS) category 3 lesions are probably benign by definition and are recommended for short-interval follow-up after a diagnostic workup has been completed. Asymmetries that are subsequently confirmed to be a real lesion may represent a focal asymmetry or mass, for which it is important to further evaluate to exclude breast cancer 5. It should be reserved for the diagnostic setting, such as when patients are recalled from screening for additional views (ie, following BI-RADS 0) or when patients present with a palpable lump.The most common cause for an asymmetry on screening mammography is superimposition of normal breast tissue (summation artifact) 6. BI-RADS 3 should not be utilized in the screening setting. FABD have also been described in a wide range of benign entities, including pyogenic or tuberculous breast infection. ![]()
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