A 45-year-old woman presents with a palpable lump. Ultrasound shows a 2 cm oval hypoechoic mass with parallel orientation, circumscribed margins, and posterior acoustic enhancement. Which BI-RADS category and recommendation are most appropriate?

• A BI-RADS 3 — 6-month follow-up ultrasound ✓
• B BI-RADS 4A — ultrasound-guided biopsy
• C BI-RADS 2 — benign finding, routine screening
• D BI-RADS 5 — immediate core biopsy

Explanation

An oval, hypoechoic, parallel (wider-than-tall), circumscribed mass with posterior acoustic enhancement on ultrasound is classic for a benign fibroadenoma or simple cyst variant, assigned BI-RADS 3 (probably benign, <2% malignancy risk). Short-interval follow-up at 6 months is recommended to confirm stability over 2 years. However, if the patient is symptomatic with a palpable lump, some clinicians upgrade to BI-RADS 4A for biopsy, but per ACR criteria the above ultrasound features alone qualify for BI-RADS 3 management. BI-RADS 2 is for definitively benign findings. BI-RADS 5 requires high-suspicion features such as spiculation or angular margins.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.