What does BIRADS on your mammography/ ultrasound report mean?

Lot of times in my Breast Clinic at CK Birla Hospital, Gurgaon, I get patients who come and tell me that they are suffering from stage III breast cancer. When I ask them how do they know about that, the answer which I usually hear is that “my mammogram/ ultrasound report shows BIRADS III.” Not only patients but I have also seen some doctors getting confused with the BIRADS reporting.

BIRADS (Breast Imaging Reporting and Data Systems) is a standardized way of reporting breast radiology reports.  This helps radiologists categorize patients from a score of 0-6 and it helps breast cancer surgeons in taking decisions based on this score. Having a uniform reporting system is useful because patients might get their radiology and breast disease treatment done at different places.

The score doesn’t imply the stage of cancer and patients should be aware of this to avoid unnecessary anxiety after seeing the radiology report.

  • BIRADS 0 means an incomplete investigation – This usually occurs when a mammogram is done in a patient with a dense breast and it does not yield any meaningful information. In such a case, usually an ultrasound or MRI Breast is done

 

  • BIRADS 1 is a negative scan, which basically implies that there is no lesion in the breast and everything is normal. In these patients we advise them to follow up after 1 year

 

  • BIRADS 2 is suggestive of a benign lesion, which has essentially a 0% risk of cancer and these lumps don’t require a biopsy. They can be followed up in a year’s time. Simple cysts, most typical fibroadenomas fall under this category.

 

  • BIRADS 3 lesions are probably benign and these breast lesions/ lumps should be followed up every 6 months (short term follow-up). These lumps do not require a biopsy/ FNAC but if you have a family history of breast cancer, then the clinician might be inclined to do more tests/ biopsy at this stage rather than wait for 6 months.  Fibroadenomas, duct ectasias can fall under this category of lesions.

 

  • BIRADS 4 breast lumps/ lesions are suspicious lesions and they need to be biopsied to confirm the diagnosis. They are further sub-divided into 4a, 4b, 4c which implies low, medium and high risk for cancer. These patients should be counselled accordingly and a tru-cut/ core needle biopsy should be scheduled as soon as possible. Atypical fibroadenomas, suspicious microcalcifications, duct papillomas usually fall under this category of lesions

 

  • BIRADS 5 lesions are highly suggestive of malignancy and the risk of cancer in these breast lumps is more than 95%. All patients with these breast lumps should be subjected to the tru-cut biopsy, which is preferred over a FNAC (fine needle aspiration cytology)

 

  • BIARDS 6 lesions are when a radiological test is done after confirming the diagnosis of breast cancer.

 

The table below summarizes the BIRADS score and the action which needs to be taken in each category.

The Radiology Assistant : Bi-RADS for Mammography and Ultrasound 2013

 

So the next time you receive your mammography / breast ultrasound report, don’t be surprised to see the BIRADS score. Discuss the report with your radiologist and breast cancer surgeon and take action accordingly. Remember, that all breast lumps are not cancerous and all of them don’t even require a biopsy/ FNAC test.

 

This information has been provided by

Dr. Rohan Khandelwal

Principal Consultant,

The Breast Centre

CK Birla Hospital, Gurugram

How medical students can utilise this lock-down period efficiently

I was in my 2nd year of post-graduation during the 2009 swine flu pandemic. 4-5 days after an emergency 24 hour duty, I developed symptoms of flu along with high fever. As per the guidelines issued, I got my test done and was detected with swine flu. Fortunately, I just had mild infection but i was forced to undergo a 12 day quarantine.

Being a second year surgery PG, when the surgical opportunities in the emergency duties are plenty, I was initially a bit frustrated but within a day or two, I decided to utilize that time wisely. I set aside 3 tasks for myself during that period and made sure that I finished them before going back to the hospital.

1) I planned to revise bailey and maheshwari for my upcoming MRCS exam

2) Submit two scientific papers in pubmed indexed journals

3) Segregate my wildlife pictures into various folders for handy use

I realized that doing just one thing the entire day wouldn’t be possible, so I allocated 4-5 hours to studies and 1 hour each to the other two tasks. This left me with enough time to exercise, watch TV for 1-2 hours a day.

At the end of the 12 days, I had accomplished all the three tasks and felt extremely happy while returning to work.

A lot of undergraduate students are going through the same phase during this lock-down and I would highly recommend that you follow these simple steps to make the most of this period

1) Make a realistic study plan for yourself : Don’t be over ambitious, otherwise you will feel disappointed at the end of 21 days. At the same time, don’t set yourself a very simple goal because that would lead to you wasting a lot of time on social media or watching netflix

2) Use this free time to work on your hobby : You might not get such a period for a long time after this. Don’t forget to read that book which has been lying on your shelf since a long time or pick up the canvas and re-juvinate your passion for drawing. These hobbies would be your stress-busters for the rest of your life and they will also allow you to break the monotony during this lock-down period

3) Each day spend quality time with your family members: Watch a movie together or play some board/ card game. You will treasure these memories life long.

4) Exercise/ meditate for at least one hour daily: I’m sure your mother’s would be pampering you with delicacies but you don’t want to end up gaining 2-3 kg’s during this period. Also, this would help you in staying sane during this phase when all you are hearing is gloomy/ depressing news regarding COIVD19

5) Try to learn some new skill – there are a lot of free courses on internet. You can probably learn a new language or hone your photography skills by doing these courses.

I have also set a few goals for myself during this period and I would like to share them with you. Will update you at the end of this period regarding the progress which I have made regarding these.

• Apply for Fellow of American College of Surgeons (FACS)

• Publish two articles regarding my breast cancer patients

• Me and Dr. Ila have sighted and clicked more than 120 Indian birds over the last 10 years. I want to print a book with all these images for our reference

• Do a online course to improve my photography skills

I hope this posts helps the undergraduate students plan these days better. Do reach out to me if you are able to make a list for yourself and keep sharing your progress with me. It will motivate me to achieve my targets as well.

covid19todolist #RohanKhandelwal

PS – attaching a pic of me and Dr. Ila Jain Khandelwal which we clicked during our swine flu quarantine period.

Support the healthcare workers during COVID19 outbreak

Healthcare workers across the world are fighting an unprecedented battle against coronavirus. The least we can do is to support them and appreciate their efforts.

Imagine a soldier returning from battle – he would be welcomed with open arms and would be pampered by friends/ family members. Is that the same happening with doctors who are risking their lives daily and working in sup-optimal conditions for 24-48 hours at a stretch. No!! Not at all. Resident doctors and PG’s are being asked to vacate their hostel/ PG accommodations because the landlords are scared that they might bring infection into the house. Their rooms are not being cleaned, they are not being served proper food. Would we do the same thing with a soldier as well??

All healthcare workers appreciated the public display of support on Sunday but is a single time act of kindness enough to support these brave souls who are risking their lives everyday? As a doctor, it is my humble request to the general public to please support all healthcare workers on a regular basis during these tough times.

– Say a simple ‘thank you’ to these people. It will help in keeping their spirits high

– Don’t ask them to vacate their rooms. They are well aware of the risks and none of them would want to infect their friends/ family members

– Stop hoarding masks/ hand sanitizers/ essential medicines. You would be surprised to know that a lot of doctors don’t have access to proper PPE’s. They are having to do with cloth masks which offer little or no protection while treating patients. Hydrochloroquine has disappeared of shelves and it is unavailable to a lot of health care workers.

– Listen to the precautions they are highlighting on a regular basis. That is the only way to reduce the spread of this condition.

These are tough times for everyone. Least we can do is to support our #COVIDwarriors at this time.

Dr. Rohan Khandelwal

A doctor, teacher and a concerned citizen