Follow-up Protocol for BI-RADS 3 Classification
For patients with a BI-RADS 3 (probably benign) classification, the recommended follow-up is diagnostic mammograms at 6 months initially, then every 6 to 12 months for a total of 1 to 2 years. 1
Initial Follow-up Protocol
- At the first 6-month follow-up, a unilateral mammogram of the index breast should be performed 1
- For women aged 40 years and older, the 12-month study should be bilateral to ensure the contralateral breast is imaged at appropriate yearly intervals 1
- Depending on the level of concern, subsequent follow-up may be either:
- Every 6 months for the breast in question, or
- Annual bilateral mammograms 1
Monitoring Outcomes
- If the lesion remains stable or resolves mammographically during the follow-up period, the patient should resume routine screening intervals for mammography 1
- If any interval mammogram shows that the lesion has increased in size or its benign characteristics have changed, a biopsy should be performed 1
Special Considerations
- Initial biopsy with histologic sampling may be a reasonable alternative to short-term follow-up in certain situations:
- When a return visit is uncertain
- When the patient is highly anxious
- When the patient has a strong family history of breast cancer
- When the patient strongly desires biopsy 1
Timing of Cancer Detection
- Research shows that the majority of malignant lesions (57.8%) are diagnosed at or before the 6-month follow-up, validating the necessity of short-interval follow-up 2
- In one study, 79.4% of malignancies were identified at the 6-month mammogram, with 8.8% at 12 months, 8.8% at 18 months, and 2.9% at 24 months 3
- The overall malignancy rate for BI-RADS 3 lesions is approximately 1.86% through 2-year follow-up, which is consistent with the expected rate of less than 2% for probably benign lesions 2, 4
Clinical Pearls and Pitfalls
- Common pitfalls in BI-RADS 3 assessment include failure to use proper BI-RADS descriptors, incomplete diagnostic workup, and overreliance on negative ultrasonographic findings 4
- When appropriately used, short-interval follow-up saves many patients from unnecessary biopsies of benign lesions without decreasing cancer detection rates 4
- Baseline screening examinations are associated with a significantly higher rate of BI-RADS 3 assessments than non-baseline examinations 5
- For MRI-detected BI-RADS 3 lesions, initial short-interval follow-up is also recommended to identify potential malignancies 6, 5
Completion of Follow-up
- After completion of the 1-2 year follow-up period with stable findings, the patient should return to routine screening 1
- If pathology and imaging findings are concordant after any biopsy, follow-up with mammography every 6 to 12 months for 1 to 2 years is recommended before returning to routine screening 1