ACR BI-RADS Mammography 報告

報告應該要含下列內容

Indication

Breast composition

4th ACR BI-RADS, 2003		5th ACR BI-RADS, 2013
1	almost entirely fat (<25% glandular)	a	almost entirely fatty
2	scattered areas of fibroglandular densities (25-50% glandular)	b	scattered areas of fibroglandular density
3	heterogeneously dense, which could obscure detection of small masses (51-75% glandular)	c	heterogeneously dense, which may obscure small masses
4	extremely dense. May lower the sensitivity of mammography (>75% glandular)	d	extremely dense, which lowers the sensitivity of mammography

*不再附上glandular的比例，因為看breast density 的變化比起去算%數，和breast cancer的risk更有關聯

Important findings

• Mass
• Calcifications
• Architectural distortion
• Asymmetries
• Intra-mammary LN
• Skin lesion
• Solitary dilated duct
• Associated findings
• Skin retraction
• Nipple retraction
• Skin thickening
• Trabecular thickening
• Axillary adenopathy
• Architectural distortion
• Calcifications
• Location of leasion
• Laterality
• UOQ/UIQ/LOW/LIQ
• Depth: anterior, middle, posterior 1/3
• Distance from nipple

Comparison to previous exams

Assessment & Management

Category 0:	Imcomplete	陽性	複檢。需進一步檢查。
Category 1:	Negative	陰性	定期追蹤。
Category 2:	Benign	陰性	定期追蹤。可能為Involuted, calcified fibroadenoma; secretory calcifications, fat-containing lesions(hamartoma, galactocele), intramammary lymph nodes, implants, prior surgery related architectural distortion, ...
Category 3:	Probably benign	陽性	短期追蹤。可能是良性。惡性機會≦2%。患部應安排半年後追蹤
Category 4:	Suspicious	陽性	組織生檢。
		4a	惡性機會2-10%
		4b	惡性機會10-50%
		4c	惡性機會50-95%
Category 5:	Highly suggestive of Malignancy	陽性	組織生檢。惡性機會≧95%
Category 6:	Proven Malignancy	陽性	可以的話應手術

Screening mammography應避免給3-6的診斷。怪怪的給0就好。
若已有症狀，則非screening，為diagnostic。臨床上要小心寫以免被核刪

Ref: 乳房X光攝影 ACR BI-RADS 判讀技巧與應用，許居誠。乳疑陽課程。2015/4/19