What does a BIRADS (Breast Imaging Reporting and Data System) score of 2 mean?

BIRADS Score 2 Means Benign Findings

A BIRADS score of 2 definitively indicates benign findings in breast imaging, with a 0% risk of malignancy. 1, 2

Definition and Characteristics of BIRADS 2

• BIRADS 2 represents a negative mammogram with benign findings present, meaning no mammographic evidence of malignancy exists 3
• Common examples of BIRADS 2 findings include:
  • Benign-appearing calcifications
  • Calcifying fibroadenomas
  • Oil cysts
  • Lipomas
  • Intramammary lymph nodes
  • Vascular calcifications
  • Implants
  • Architectural distortion clearly related to prior surgery 1

Clinical Significance and Management

• BIRADS 2 lesions have been validated to have a 0% risk of malignancy in clinical studies 2
• Research confirms that breast biopsies are unnecessary for BIRADS 2 lesions 4
• The appropriate management for BIRADS 2 findings is to resume routine screening mammography in 1 year 1
• No additional diagnostic workup is required for BIRADS 2 findings as they are definitively benign 3

BIRADS Classification System Context

• BIRADS was developed by the American College of Radiology to standardize breast imaging reporting 3
• The classification system helps guide clinical management based on imaging findings 1
• For comparison with other categories:
  • BIRADS 1: Negative (no findings)
  • BIRADS 2: Benign findings (0% malignancy risk)
  • BIRADS 3: Probably benign (<2% malignancy risk)
  • BIRADS 4: Suspicious abnormality (variable malignancy risk)
  • BIRADS 5: Highly suggestive of malignancy (≥95% malignancy risk)
  • BIRADS 6: Known biopsy-proven malignancy 3, 1

Important Clinical Considerations

• When multiple imaging modalities are used (e.g., mammography and ultrasound), the BIRADS categories represent the cumulative findings 3, 1
• The overall BIRADS assessment is always based on the most worrisome finding when multiple abnormalities are present 3
• Unlike BIRADS 3 lesions which require short-interval follow-up, BIRADS 2 findings require only routine screening 1, 5
• Studies have confirmed that the positive predictive value for malignancy in BIRADS 2 lesions is 0%, supporting the safety of routine follow-up 2