BI-RADS 2: Benign Findings - No Action Required
A BI-RADS 2 classification on mammogram is a negative result indicating benign (non-cancerous) findings that require no further workup, only routine annual screening mammography. 1, 2
What BI-RADS 2 Means
BI-RADS 2 is essentially a negative mammogram where benign findings are explicitly documented. 1 This category carries zero risk of malignancy and is used when the radiologist identifies specific benign features that they want to describe in the report. 3
Common Benign Findings in BI-RADS 2:
- Calcifying fibroadenomas - benign breast tumors with characteristic calcifications 1
- Oil cysts - fluid-filled sacs containing fat from prior trauma or surgery 1
- Lipomas - benign fatty tumors 1
- Intramammary lymph nodes - normal lymph nodes within breast tissue 1
- Vascular calcifications - calcium deposits in blood vessel walls 1
- Breast implants 1
- Architectural distortion clearly related to prior surgery 1
Clinical Management
The recommended management for BI-RADS 2 is routine screening mammography in 1 year. 1, 2 No additional imaging, no biopsy, and no short-interval follow-up are needed. 1, 2
Key Distinction from BI-RADS 1:
- BI-RADS 1 = completely normal mammogram with no findings to describe 1
- BI-RADS 2 = normal mammogram but with benign findings the radiologist chooses to document 1
Both categories are negative and have the same management (annual screening). 1, 2
Evidence Supporting Zero Malignancy Risk
Research confirms that the frequency of malignancy in lesions classified as BI-RADS 2 is zero (0%). 3 In a study of 192 patients with BI-RADS 2 lesions followed for 2-9 years, no malignancies were identified, confirming that breast biopsies are unnecessary in these cases. 3
Important Clinical Pitfalls to Avoid
Do not order additional imaging or biopsy for BI-RADS 2 findings. 1, 2 The most common error is over-investigating these benign findings due to patient anxiety or misunderstanding of the classification system.
Reassure patients that BI-RADS 2 is a negative result. 1 While findings are present, they are definitively benign and require no intervention beyond routine screening.