Breast MRI Lesion Classification Tree

Does the lesion show enhancement?

Is this a mass or non-mass lesion?

Enhancing mass lesion present. Is the lesion spiculated ("root sign")?

Enhancing non-mass lesion present. Is the lesion spiculated ("root sign")?

What is the enhancement curve of the lesion after contrast administration?

What is the enhancement curve of the lesion after contrast administration?

Are the margins irregular or smooth?

What is the internal enhancement pattern like?

Is there edema in the breast tissue?

Are the margins irregular or smooth?

What is the internal enhancement pattern like?

Is there edema in the breast tissue?

BIRADS 2, no sign of malignancy, likelihood of cancer <1%.

Kaiser Score 1 - BIRADS 2/3, benign finding with low risk of cancer.

Kaiser Score 2 - BIRADS 2/3, benign finding with low risk of cancer.

Kaiser Score 3 - BIRADS 2/3, benign finding with low risk of cancer.

Kaiser Score 4 - BIRADS 2/3, benign finding with low risk of cancer.

Kaiser Score 5 - BIRADS 4, suspicious finding with intermediate risk of cancer.

Kaiser Score 6 - BIRADS 4, suspicious finding with intermediate risk of cancer.

Kaiser Score 7 - BIRADS 4, suspicious finding with intermediate risk of cancer.

Kaiser Score 8 - BIRADS 5, high risk of breast cancer.

Kaiser Score 9 - BIRADS 5, high risk of breast cancer.

Kaiser Score 10 - BIRADS 5, high risk of breast cancer.

Kaiser Score 11 - BIRADS 5, high risk of breast cancer.

Recommendation: In case of newly diagnosed lesions, most guidelines recommend follow-up to exclude lesion growth. If follow-up is requested, it should be performed by ultrasound, if possible. If not visible on conventional imaging, follow-up intervals should be 6 months (mass lesions) or 12 months (non-mass lesions).

Recommendation: Follow-up in usual re-screening interval.

Recommendation: Image-guided biopsy recommended. Biopsy should be performed by ultrasound, if possible. If not visible on conventional imaging, MRI-guided biopsy is required.

Recommendation: Image-guided biopsy recommended. Biopsy should be performed by ultrasound, if possible. If not visible on conventional imaging, MRI-guided biopsy is required. In case of benign biopsy results, short-term follow-up or re-biopsy is mandatory.


© 2018 Pascal Baltzer, Daniel Toth (daniel.toth@meduniwien.ac.at)