Management of Fibroadenosis with BI-RADS 2 Classification
For fibroadenosis classified as BI-RADS 2, return immediately to routine annual screening mammography without any short-term follow-up imaging or biopsy. 1, 2
Understanding BI-RADS 2 Classification
BI-RADS 2 represents definitively benign findings with characteristic features including calcifying fibroadenomas, oil cysts, lipomas, intramammary lymph nodes, and other clearly benign lesions. 1 The malignancy rate for BI-RADS 2 lesions is zero based on prospective validation studies. 3
Recommended Management Algorithm
Routine screening only: Resume annual mammography (for women ≥40 years) without any additional imaging or short-term follow-up. 2 This differs fundamentally from BI-RADS 3 lesions, which require 6-month follow-up imaging. 1, 2
No biopsy indicated: Tissue diagnosis is unnecessary for BI-RADS 2 lesions, as they represent definitively benign findings. 4, 3
For symptomatic patients: If the fibroadenosis includes simple cysts causing persistent clinical symptoms (pain, discomfort), therapeutic aspiration may be performed for symptom relief, after which the patient returns to routine screening. 4, 2
Critical Clinical Concordance Requirement
Before assigning BI-RADS 2 to a palpable finding, ensure concordance between clinical examination and imaging findings. 2 If a palpable mass is present:
- Ultrasound confirmation is required to verify that the imaging finding definitively correlates with the clinical finding. 4
- If correlation between the mammographic finding and palpable lesion is uncertain, targeted ultrasound to the palpable area is indicated. 4
- Only when clinical and imaging findings are concordant should routine screening be recommended. 4, 2
Common Pitfalls to Avoid
Do not confuse BI-RADS 2 with BI-RADS 3: BI-RADS 3 (probably benign) lesions have <2% malignancy risk and require short-term follow-up at 6 months, then every 6-12 months for 1-2 years. 1 BI-RADS 2 lesions require no follow-up beyond routine screening. 2
Avoid unnecessary biopsies: A study of 192 BI-RADS 2 lesions with histopathologic verification or 2-9 years follow-up demonstrated zero malignancies, confirming that biopsies are unnecessary. 3
Verify true benign features: Ensure the lesion has characteristic benign morphology (such as coarse "popcorn-like" calcifications in fibroadenomas, fat density in lipomas, or reniform shape of lymph nodes) before assigning BI-RADS 2. 1