Suspicious
What is an evaluation of “Suspicious”?
According to the BI-RADS Atlas, “This category is reserved for findings that do not have the classic appearance of malignancy but are sufficiently suspicious to justify a recommendation for biopsy” (Sickles et al., 2013).
What is the BI-RADS Classification for “Suspicious”?
The BI-Rads Classification for “Suspicious” is Category 4.
What are the subcategories of a BI-RADS Category 4: Suspicious?
There are three subcategories for this evaluation:
- 4A: The BI-RAD atlas assigns 4A as “a finding needing intervention but with a low suspicion for malignancy” (Sickles et al., 2013).
- 4B: The BI-RAD Atlas assigns 4B as “lesions with a moderate suspicion for malignancy. Findings in this category warrant careful radiologic and pathologic correlation after percutaneous tissue diagnosis” (Sickles et al., 2013).
- 4C: The BI-RAD Atlas assigns 4C as “findings that have a high suspicion for malignancy but that are not highly suggestive of malignancy (category 5). The range of likelihood of malignancy for category 4C assessments is > 50% to < 95%, more likely malignant than benign and therefore properly termed "high suspicion’’” (Sickles et al., 2013).
What is the likelihood of a cancer diagnosis for an individual given an evaluation of “Suspicious”?
The answer is dependent on the category of the “Suspicious” evaluation. Refer to the table below for different cancer likelihoods:
Why are there 3 subcategories for the BI-RADS Category 4: “Suspicious”?
According to the BI-RAD Atlas, the subdivision of category 4 helps “to account for the vast range of lesions subjected to interventional procedures and corresponding broad range of likelihood of malignancy. This allows a more meaningful practice audit, is useful in research involving receiver operating characteristic (ROC) curve analysis, and is an aid for clinicians and pathologists. The optional division of category 4 into three subdivisions, internally at the facility level, helps to accomplish these goals” (Sickles et al., 2013).
When should follow-up be completed for an individual with an evaluation of “Suspicious”?
The consensus on an evaluation of “Suspicious” tends to be 6 months for a routine follow-up, but only after an evaluation of benign from tissue biopsy.
Sources:
Sickles, EA, D'Orsi CJ, Bassett LW, et al. (2013). ACR Bl-RADS Mammography. In: ACR Bl-RADS Atlas, Breast Imaging Reporting and Data System. American College of Radiology. https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/Bi-Rads#Mammography