BI-RADS calculator for breast ultrasound

Type of finding

Shape

Orientation

Margin

Echo pattern

Posterior acoustic features

Other

Follow-up

Context

Suggested categoryBI-RADS 3

Sentence for the report

Guidance based on the ACR BI-RADS 5th edition lexicon. The final category integrates mammography, clinical findings and prior exams and is the physician’s responsibility.

How the category is defined

On ultrasound, BI-RADS is not a sum of points. The category comes from the lexicon descriptors: an oval mass, parallel to the skin, with circumscribed margins and no posterior shadowing has probably benign features; any suspicious descriptor changes the category.

Category	Meaning	Management
BI-RADS 0	Incomplete assessment	Complement with another exam
BI-RADS 1	Negative	Routine screening
BI-RADS 2	Benign finding	Routine screening
BI-RADS 3	Probably benign (up to 2%)	Follow-up in 6 months
BI-RADS 4A / 4B / 4C	Low, moderate and high suspicion	Biopsy
BI-RADS 5	Highly suspicious (95% or more)	Biopsy
BI-RADS 6	Proven malignancy	Treatment

The descriptors that take the mass out of BI-RADS 3

Irregular shape.
Not parallel orientation (taller than wide).
Non-circumscribed margin: indistinct, angular, microlobulated or spiculated.
Posterior acoustic shadowing.
Solid component in a cystic lesion and calcifications in the mass.

To go deeper into lesion description and report structure, see our article on BI-RADS in breast ultrasound and the breast report template.

Frequently asked questions

Does ultrasound BI-RADS use a point score?

No. Unlike TI-RADS, BI-RADS does not add up points: the category is an assessment based on the lexicon descriptors, the clinical context and comparison with prior exams. The calculator organizes that assessment, but the final category is the physician’s call.

What is the difference between BI-RADS 3 and 4?

BI-RADS 3 is probably benign (risk up to 2%) and goes to follow-up in 6 months. BI-RADS 4 has at least one suspicious finding and indicates biopsy. A single suspicious descriptor (non-circumscribed margin, irregular shape, not parallel orientation) already takes the mass out of category 3.

How do you subdivide BI-RADS 4 into A, B and C?

The ACR defines the risk ranges (4A from 2% to 10%, 4B from 10% to 50%, 4C from 50% to 95%), but not a fixed descriptor rule. In practice, a single suspicious finding is usually 4A and additional findings raise the category, as this calculator does.

When should BI-RADS 0 be used on ultrasound?

When the assessment is incomplete and another exam is needed to conclude, for example mammography. In second-line ultrasound, with mammography available, the report should integrate both and give a final category.

In Laudário, BI-RADS is calculated inside the report.

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