European Radiology

, Volume 27, Issue 8, pp 3211–3216 | Cite as

Management for BI-RADS category 3 lesions detected in preoperative breast MR imaging of breast cancer patients

  • Hye Mi Gweon
  • Nariya ChoEmail author
  • Soo-Yeon Kim
  • Hye Ryoung Koo
  • Mirinae Seo
  • Ajung Chu
  • Eun Ju Son



To retrospectively evaluate characteristics of and determine appropriate follow-up recommendations for BI-RADS category 3 lesions detected in preoperative MRI of breast cancer patients.


BI-RADS category 3 assessments were identified from the breast MRI database for 5,110 consecutive breast cancer patients who had undergone preoperative MRI and surgery. Patient and lesion characteristics, malignancy rate, and interval between lesion detection and cancer diagnosis were analysed. Histopathological results or imaging at or after 2-year follow-up were used as reference standards.


Of the 626 lesions, morphological features included a single focus in 26.5% (n = 166), multiple foci in 47.1% (n = 295), mass in 21.7% (n = 136) and non-mass enhancement in 4.6% (n = 29). Cancer was found in 0.8% (5/626) at a median interval of 50 months (range, 29–66 months). Malignancy rate according to morphological feature was: 1.8% (3/166) in a single focus, 0.7% (1/136) in mass and 3.4% (1/29) in non-mass enhancement. All detected cancers were stage 0 or IA.


Annual follow-up might be adequate for BI-RADS category 3 lesions detected at preoperative MRI because of the 0.8% (5/626) malignancy rate, long interval between lesion detection and cancer diagnosis, and early stage of diagnosed cancers.

Key Points

BI-RADS category 3 lesions on preoperative MRI had 0.8% malignancy rate.

All cancer diagnoses from BI-RADS 3 occurred after 24-month follow-up.

Annual follow-up might be adequate for BI-RADS 3 detected on preoperative MRI.


Breast cancer Magnetic resonance imaging Follow-up studies Imaging Appointments and schedule 


Compliance with ethical standards


The scientific guarantor of this publication is Nariya Cho.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.


The authors state that this work has not received any funding.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Ethical approval

Institutional Review Board approval was obtained.

Informed consent

Written informed consent was waived by the Institutional Review Board.


  • retrospective

  • observational

  • performed at one institution


  1. 1.
    Sickles EA (1991) Periodic mammographic follow-up of probably benign lesions: results in 3,184 consecutive cases. Radiology 179:463–468CrossRefPubMedGoogle Scholar
  2. 2.
    Varas X, Leborgne F, Leborgne JH (1992) Nonpalpable, probably benign lesions: role of follow-up mammography. Radiology 184:409–414CrossRefPubMedGoogle Scholar
  3. 3.
    Varas X, Leborgne JH, Leborgne F, Mezzera J, Jaumandreu S, Leborgne F (2002) Revisiting the mammographic follow-up of BI-RADS category 3 lesions. AJR Am J Roentgenol 179:691–695CrossRefPubMedGoogle Scholar
  4. 4.
    Vizcaino I, Gadea L, Andreo L et al (2001) Short-term follow-up results in 795 nonpalpable probably benign lesions detected at screening mammography. Radiology 219:475–483CrossRefPubMedGoogle Scholar
  5. 5.
    Chae EY, Cha JH, Shin HJ, Choi WJ, Kim HH (2016) Reassessment and follow-up results of BI-RADS category 3 lesions detected on screening breast ultrasound. AJR Am J Roentgenol 206:666–672CrossRefPubMedGoogle Scholar
  6. 6.
    Chung CS, Giess CS, Gombos EC et al (2014) Patient compliance and diagnostic yield of 18-month unilateral follow-up in surveillance of probable benign mammographic lesions. AJR Am J Roentgenol 202:922–927CrossRefPubMedGoogle Scholar
  7. 7.
    Lourenco AP, Chung MT, Mainiero MB (2014) Probably benign breast MRI lesions: frequency, lesion type, and rate of malignancy. J Magn Reson Imaging 39:789–794CrossRefPubMedGoogle Scholar
  8. 8.
    Spick C, Szolar DH, Baltzer PA et al (2014) Rate of malignancy in MRI-detected probably benign (BI-RADS 3) lesions. AJR Am J Roentgenol 202:684–689CrossRefPubMedGoogle Scholar
  9. 9.
    Grimm LJ, Anderson AL, Baker JA et al (2015) Frequency of malignancy and imaging characteristics of probably benign lesions seen at breast MRI. AJR Am J Roentgenol 205:442–447CrossRefPubMedGoogle Scholar
  10. 10.
    Chikarmane SA, Birdwell RL, Poole PS, Sippo DA, Giess CS (2016) Characteristics, malignancy rate, and follow-up of BI-RADS category 3 lesions identified at breast MR imaging: implications for MR image interpretation and management. Radiology. doi: 10.1148/radiol.2016151548:151548 PubMedGoogle Scholar
  11. 11.
    Ikeda DM, Hylton NM, Kuhl CK et al (2003) ACR BI-RADS® magnetic resonance imaging. In: ACR BI-RADS® atlas, breast imaging and reporting and data system, Reston, VA, American College of RadiologyGoogle Scholar
  12. 12.
    Weinstein SP, Hanna LG, Gatsonis C, Schnall MD, Rosen MA, Lehman CD (2010) Frequency of malignancy seen in probably benign lesions at contrast-enhanced breast MR imaging: findings from ACRIN 6667. Radiology 255:731–737CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Eby PR, DeMartini WB, Gutierrez RL, Lehman CD (2010) Probably benign lesions detected on breast MR imaging. Magn Reson Imaging Clin N Am 18:309–321CrossRefPubMedGoogle Scholar
  14. 14.
    Fleiss JL (1971) Measuring nominal scale agreement among many raters. Psychol Bull 76:378–382CrossRefGoogle Scholar
  15. 15.
    Gruber R, Jaromi S, Rudas M et al (2013) Histologic work-up of non-palpable breast lesions classified as probably benign at initial mammography and/or ultrasound (BI-RADS category 3). Eur J Radiol 82:398–403CrossRefPubMedGoogle Scholar
  16. 16.
    Eby PR, DeMartini WB, Gutierrez RL, Saini MH, Peacock S, Lehman CD (2009) Characteristics of probably benign breast MRI lesions. AJR Am J Roentgenol 193:861–867CrossRefPubMedGoogle Scholar
  17. 17.
    Gilbert FJ, Warren RM, Kwan-Lim G et al (2009) Cancers in BRCA1 and BRCA2 carriers and in women at high risk for breast cancer: MR imaging and mammographic features. Radiology 252:358–368CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  1. 1.Department of RadiologySeoul National University College of Medicine, Seoul National University HospitalSeoulRepublic of Korea
  2. 2.Department of RadiologyGangnam Severance Hospital, Yonsei University College of MedicineSeoulRepublic of Korea
  3. 3.Department of RadiologyHanyang University College of MedicineSeoulRepublic of Korea
  4. 4.Department of RadiologyKyung Hee University College of MedicineSeoulRepublic of Korea
  5. 5.Department of RadiologySeoul National University College of Medicine, Boramae Medical CenterSeoulRepublic of Korea

Personalised recommendations