From the Guidelines
The mammogram shows an asymmetric density in the left breast at the 3 o'clock position that requires additional imaging, and you should schedule a follow-up appointment for spot compression mammography views and possibly an ultrasound of this area, as classified as BI-RADS 0, indicating an incomplete evaluation that needs further assessment. The radiologist has not identified any dominant masses, suspicious microcalcifications, or architectural distortions, which is reassuring 1. However, asymmetric densities sometimes need closer examination to determine if they represent normal breast tissue variation or something that requires further investigation. The additional imaging will provide clearer views of the area in question and help determine if any further action is needed.
According to the NCCN clinical practice guidelines in oncology, a BI-RADS category 0 is defined as “Needs Additional Imaging Evaluation and/or Prior Mammograms for Comparison” 1. This category is assigned when a finding requires additional evaluation, and a recommendation for additional imaging evaluation may include spot compression, magnification, special mammographic views, and ultrasound.
Key points to consider in this case include:
- The asymmetric density is located in the left breast at the 3 o'clock position
- No dominant masses, suspicious microcalcifications, or architectural distortions are present
- The radiologist recommends additional imaging with spot compression mammography views and possibly an ultrasound
- The BI-RADS classification is 0, indicating an incomplete evaluation that needs further assessment
It is essential to follow up with the recommended imaging to determine the nature of the asymmetric density and to ensure a thorough evaluation, as suggested by the NCCN guidelines 2. Completing the recommended follow-up is crucial for a thorough evaluation, and it does not necessarily indicate cancer, but rather a need for further investigation to determine the cause of the asymmetric density.
From the Research
Breast Imaging Reporting and Data System (BI-RADS) Category
- The given impression is BI-RADS 0, indicating an incomplete assessment that requires additional imaging evaluation 3.
- BI-RADS 0 is assigned when the radiologist needs more information to make a final assessment, such as when a spot compression or ultrasound is required to further evaluate an asymmetric density.
Asymmetric Density in the Breast
- An asymmetric density is seen in the lateral left breast at the 3 o'clock position, requiring spot compression with an option for ultrasound.
- Asymmetric densities can be a normal finding, but they can also be associated with malignancy, which is why further evaluation is necessary 4.
Role of Artificial Intelligence and Ultrasound in Breast Cancer Diagnosis
- Artificial intelligence (AI) and high frame-rate contrast-enhanced ultrasound (HiFR-CEUS) have been shown to improve the diagnostic accuracy of breast cancer, particularly in distinguishing between benign and malignant BI-RADS 4 breast nodules 5.
- A machine learning model based on radiomics can predict the BI-RADS category of ultrasound-detected suspicious breast lesions and support medical decision-making towards short-interval follow-up versus tissue sampling 6.
Diagnostic Performance of AI and HiFR-CEUS
- The combination of AI and HiFR-CEUS has been shown to have higher diagnostic performance than either modality alone in distinguishing between benign and malignant BI-RADS 4 breast nodules 5.
- A two-stage augmentation method using deep convolution networks has been proposed to improve the detection rate of BI-RADS 3 malignant lesions on breast ultrasound images 7.