Management of Women with BI-RADS 2 Lesions
Women with BI-RADS 2 (benign) lesions should return to routine annual screening mammography without any additional imaging, follow-up, or biopsy. 1
Understanding BI-RADS 2 Classification
BI-RADS 2 represents definitively benign findings that carry essentially zero risk of malignancy:
- BI-RADS 2 lesions have a 0% malignancy rate, as demonstrated in a study of 192 consecutive patients where no malignancies were identified among lesions classified as BI-RADS 2 on breast imaging 2
- These are lesions with characteristic benign features such as simple cysts, intramammary lymph nodes, lipomas, oil cysts, calcified fibroadenomas, and other clearly benign findings 1
Recommended Management Algorithm
For Asymptomatic BI-RADS 2 Lesions
- Return to routine screening intervals (typically annual mammography for women ≥40 years) without any short-term follow-up 1
- No biopsy is indicated for BI-RADS 2 lesions, as the frequency of malignancy is zero 2
- No additional imaging beyond routine screening is necessary 1
Special Circumstance: Symptomatic Simple Cysts
- If a BI-RADS 2 simple cyst is causing persistent clinical symptoms, therapeutic aspiration may be performed for symptom relief 1
- After aspiration of a symptomatic simple cyst with concordant clinical and imaging findings, the patient returns to routine screening 1
Critical Distinction from BI-RADS 3
It is essential not to confuse BI-RADS 2 with BI-RADS 3 (probably benign), as management differs substantially:
- BI-RADS 3 lesions require short-term follow-up at 6 months, then every 6-12 months for 1-2 years 1, 3
- BI-RADS 2 lesions require no follow-up beyond routine screening 1
Common Pitfalls to Avoid
- Do not order short-term follow-up imaging for BI-RADS 2 lesions—this represents overutilization of resources and unnecessary patient anxiety 2
- Ensure concordance between clinical examination and imaging before assigning BI-RADS 2 to a palpable finding; if a palpable mass corresponds to a BI-RADS 2 imaging finding (such as a simple cyst), ultrasound confirmation of concordance is required before returning to routine screening 1
- Do not perform biopsies on BI-RADS 2 lesions, as they are definitively benign 2