A 52-year-old woman's screening mammogram shows a 12 mm irregular mass with spiculated margins and associated pleomorphic microcalcifications in the upper outer quadrant. According to ACR BI-RADS, what is the correct assessment category?
- A BI-RADS 3 — Probably benign (short-interval follow-up)
- B BI-RADS 4A — Low suspicion for malignancy
- C BI-RADS 5 — Highly suggestive of malignancy (≥95% PPV) ✓
- D BI-RADS 6 — Known biopsy-proven malignancy
Correct answer: C. BI-RADS 5 — Highly suggestive of malignancy (≥95% PPV)
Explanation
BI-RADS 5 is assigned when findings are highly suggestive of malignancy with a positive predictive value ≥95%; the combination of an irregular spiculated mass with pleomorphic microcalcifications is classic for invasive breast carcinoma and warrants BI-RADS 5 categorization, mandating tissue diagnosis. BI-RADS 4 covers a spectrum (4A–4C) from low to high suspicion but does not reach 95% PPV. BI-RADS 3 (≤2% malignancy risk) is appropriate for well-defined oval masses, not spiculated lesions. BI-RADS 6 is only for known histological diagnosis.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
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