The Breast Ultrasound Lexicon: Breast Imaging Reporting and Data System (BI-RADS)

Sedgwick E. The Breast Ultrasound Lexicon: Breast Imaging Reporting and Data System (BI-RADS). Semin Roentgenol 2011; 46(4):245-251

A radiologist’s ability to perceive an abnormality on an image is not unlike an art critic’s ability to perceive the significance of color choice when evaluating a painting. Perception is a learned skill, refined over time, and difficult to quantify. Some have better perception than others. Radiology residents are given the example of “Aunt Minnie,” a term coined by the late Dr Edward B. Neuhauser, the former chief of Radiology at Boston Children’s Hospital. An “Aunt Minnie” refers to a radiology finding pathognomonic for a disease. A radiologist should be able to perceive a finding because he or she has seen it many times before, like one recognizes his or her Aunt Minnie.

Unfortunately, not all imaging findings are pathognomonic for a specific disease. Consequently, radiologists need to identify several different features in an attempt to specifically characterize a lesion. Breast cancer can present on imaging studies in many fashions, requiring a combination of perceptions to make a specific diagnosis. Mammography remains the gold standard for the detection of breast cancer, although the sensitivity is approximately 75%. Ultrasound has been used primarily as a complementary tool to mammography to discern solid masses from cysts, thereby improving the specificity of mammography. Sonography is an operator-dependent modality. When operator dependence is combined with the variety of ways a feature can be described, the utility of ultrasound is hampered. Stavros et al defined several ultrasound characteristics to predict the likelihood of malignancy when evaluating a solid mass. Other authors attempted to reproduce the results of Stavros et al with varied success.
Consequently, the creation of a lexicon was advocated for better communication of findings and so that standard terms could be used as the basis for ultrasound research. The bulk of breast ultrasound research pertains to the use of sonography in conjunction with mammography.

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