A 50-year-old woman undergoes screening mammography. A 12 mm spiculated mass with associated fine pleomorphic calcifications is identified in the upper outer quadrant of the right breast. According to ACR BI-RADS (5th edition), what is the appropriate BI-RADS category and recommended action?

• A BI-RADS 4B — biopsy recommended
• B BI-RADS 4C — biopsy recommended
• C BI-RADS 3 — short-interval follow-up in 6 months
• D BI-RADS 5 — biopsy recommended (highly suggestive of malignancy) ✓

Explanation

A spiculated mass with fine pleomorphic microcalcifications is highly suspicious for malignancy; this combination carries a >95% positive predictive value (PPV) for breast cancer. ACR BI-RADS 5 indicates findings that are 'highly suggestive of malignancy' (PPV >95%) and mandates tissue sampling (biopsy). BI-RADS 4 is subdivided into 4A (low suspicion, PPV 2–10%), 4B (moderate, 10–50%), 4C (high, 50–95%). BI-RADS 3 (PPV ≤2%) is reserved for probably benign findings requiring 6-month follow-up.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.