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Training Collections
Library Memberships
On-demand course library with video lectures, expert case reviews, and more
Fellowship Certificate™ Programs
Practice-focused training programs designed to help you gain experience in a specific subspecialty area.
Ultimate Learning Pass
Unlock access to our full Course Library and all self-paced Fellowships.
Continuing Medical Education (State CME)
Complete all of your state CME requirements in one convenient place.
Noon Conference (Free)
Get access to free live lectures, every week, from top radiologists.
Case of the Week (Free)
Get a free weekly case delivered right to your inbox.
Case Crunch: Rapid Case Review (Free)
Register for free live board reviews.
Dr. Resnick's MSK Conference
Learn directly from the MSK Master himself.
Lower Extremities MRI Conference
Musculoskeletal Imaging
Emergency Imaging
PET Imaging
Pediatric Imaging
For Training Programs
Supplement your training program with case-based learning for residents, registrars, fellows, and more.
For Private Practices
Upskill in high growth, advanced imaging areas.
Compliance
NewTrack, fulfill, and report on all your radiologists' credentialing and licensing requirements.
Emergency Call Prep
Prepare trainees to be on call for the emergency department with this specialized training series.
1 topic, 2 min.
2 topics, 5 min.
5 topics, 33 min.
3 topics, 14 min.
8 topics, 28 min.
4 topics, 20 min.
4 topics, 25 min.
22 topics, 1 hr. 17 min.
BI-RADS Assessment Categories – Overview
11 m.BI-RADS 1
5 m.BI-RADS 2 – Left Lumpectomy
4 m.BI-RADS 2 – Right Lumpectomy, Right Non-Enhancing Mass
2 m.BI-RADS 2 – Left Post Excisional Biopsy Change
3 m.BI-RADS 2 – Marked BPE, Stable
3 m.BI-RADS 2 – Bilateral Stable Findings
4 m.New focus of enhancement on a high risk patient (BI-RADS 4)
3 m.BI-RADS 3 – Changing Pattern of Background
2 m.BI-RADS 4 – Linear NME, Left Breast
4 m.BI-RADS 4 – Right Extensive DCIS, Left Dominant Focus
4 m.BI-RADS 4 – New Diagnosis Left Cancer, Focal NME left
3 m.BI-RADS 4 – New Diagnosis Right Breast Cancer, Nodes on Right
5 m.BI-RADS 4 – Left Axillary Node Metastasis, Evaluate for Breast Cancer
3 m.BI-RADS 5 – Suspicious Mass in Left Breast, Not Biopsied Yet
5 m.BI-RADS 5 – Left Breast Cancer, MRI Shows Right Cancer
5 m.BI-RADS 5 – New Diagnosis Right Cancer, Suspicious Masses in Right Breast
3 m.BI-RADS 5 – Right Inflammatory Cancer, Bilateral Nodes
4 m.BI-RADS 6 – Right Breast Cancer, No Other Findings
3 m.BI-RADS 6 – Left Breast Cancer, No Other Findings
2 m.BI-RADS 6 – Left Breast Cancer, Index Mass
4 m.BI-RADS 6 – Pre and Post Neoadjuvant Chemotherapy (NAC) for Left Breast Cancer
5 m.0:01
So our next group of cases
0:02
was categorized as BI-RADS 4.
0:06
And our first case is a 65-year-old woman
0:08
with a history of LCIS and atypia, so
0:13
atypical ductal hyperplasia and atypical
0:15
lobular hyperplasia in the left breast, and
0:18
she's being seen for high-risk screening.
0:22
So we're looking at the patient's MIP first, and
0:25
you can see she has mild background parenchymal
0:27
enhancements, some normal blood vessels, and
0:30
there's sort of a prominent linear non-mass
0:32
enhancement here in the left breast laterally.
0:36
Okay.
0:36
So we'll take another look at everything.
0:41
So we're going to pull in her T1 non-FATSAT
0:45
and her first subtracted image or series.
0:51
And we can see that she has a lot
0:53
of fibroglandular tissue, sort of
0:54
heterogeneous to extreme, and she's
1:00
had prior surgery and biopsies.
1:02
So there's a biopsy clip artifact here in the
1:05
left breast and also here in the left breast.
1:16
And then she's had a post-surgical change
1:21
here with a post-surgical collection.
1:23
So that was at a biopsy site or
1:26
excisional biopsy site for LCIS.
1:32
And we can see that she has fairly mild
1:34
background parenchymal enhancement.
1:41
And as we're scrolling through, the most
1:43
noticeable thing is just this linear non-mass
1:48
enhancement here in the anterior left breast.
1:54
It seems it's a little bit
1:57
more than just this part.
1:59
There's a little bit more to it
2:00
going backwards or going posteriorly.
2:04
You can see there kind of
2:06
extends a little bit longer.
2:09
And this was
2:10
new or certainly more prominent
2:12
compared to prior studies.
2:14
So that was concerning.
2:17
We also looked at the pre and post images.
2:22
Sometimes that gives you a
2:23
different look at this area.
2:27
We can see that it's right at
2:28
the edge of her tissue here.
2:35
It really wasn't anything
2:36
else on any of her images.
2:40
And we went through every, every series.
2:43
So this linear non-mass enhancement
2:46
in a fairly high-risk person who
2:49
has had prior episodes of atypia.
2:53
We were concerned enough about this that we
2:55
recommended an MRI-guided biopsy, which was
2:58
done, and this was a lobular carcinoma in situ.
3:02
So she returned to her surgeon for
3:06
an additional excisional biopsy.
3:10
So this was a BI-RADS 4.
Interactive Transcript
0:01
So our next group of cases
0:02
was categorized as BI-RADS 4.
0:06
And our first case is a 65-year-old woman
0:08
with a history of LCIS and atypia, so
0:13
atypical ductal hyperplasia and atypical
0:15
lobular hyperplasia in the left breast, and
0:18
she's being seen for high-risk screening.
0:22
So we're looking at the patient's MIP first, and
0:25
you can see she has mild background parenchymal
0:27
enhancements, some normal blood vessels, and
0:30
there's sort of a prominent linear non-mass
0:32
enhancement here in the left breast laterally.
0:36
Okay.
0:36
So we'll take another look at everything.
0:41
So we're going to pull in her T1 non-FATSAT
0:45
and her first subtracted image or series.
0:51
And we can see that she has a lot
0:53
of fibroglandular tissue, sort of
0:54
heterogeneous to extreme, and she's
1:00
had prior surgery and biopsies.
1:02
So there's a biopsy clip artifact here in the
1:05
left breast and also here in the left breast.
1:16
And then she's had a post-surgical change
1:21
here with a post-surgical collection.
1:23
So that was at a biopsy site or
1:26
excisional biopsy site for LCIS.
1:32
And we can see that she has fairly mild
1:34
background parenchymal enhancement.
1:41
And as we're scrolling through, the most
1:43
noticeable thing is just this linear non-mass
1:48
enhancement here in the anterior left breast.
1:54
It seems it's a little bit
1:57
more than just this part.
1:59
There's a little bit more to it
2:00
going backwards or going posteriorly.
2:04
You can see there kind of
2:06
extends a little bit longer.
2:09
And this was
2:10
new or certainly more prominent
2:12
compared to prior studies.
2:14
So that was concerning.
2:17
We also looked at the pre and post images.
2:22
Sometimes that gives you a
2:23
different look at this area.
2:27
We can see that it's right at
2:28
the edge of her tissue here.
2:35
It really wasn't anything
2:36
else on any of her images.
2:40
And we went through every, every series.
2:43
So this linear non-mass enhancement
2:46
in a fairly high-risk person who
2:49
has had prior episodes of atypia.
2:53
We were concerned enough about this that we
2:55
recommended an MRI-guided biopsy, which was
2:58
done, and this was a lobular carcinoma in situ.
3:02
So she returned to her surgeon for
3:06
an additional excisional biopsy.
3:10
So this was a BI-RADS 4.
Report
Description
Faculty
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
Tags
Women's Health
Neoplastic
MRI
Breast
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