17. ACR BI-RADS category
Breast Imaging Reporting and Data System
Standard descriptions for
Mammography
Breast US
MRI
Standard reporting
Final Assessment Categories
17
18. BI-RADS category
Final Assessment Categories
0= Need additional imaging evaluation or prior mammograms for
comparison (需要其他影像檢查)
1= Negative, There is nothing to comment on (無顯著發現)
2= Benign findings (良性病灶,每年追蹤一次)
3= Probably benign finding (<2% malignant), initial short-interval follow-up
(良性病灶, 惡性機率 <2%, 建議密集追蹤)
4= Suspicious abnormality (2-95% malignant), biopsy should be considered
(懷疑有問題, 惡性機率 2-95%, 需要組織確認)
5= Highly suggestive of malignant (>95% malignant)
(高度懷疑為惡性組織, >95%)
6= Known Biopsy-Proved Malignancy (已被確診為惡性腫瘤)
23. Breast Conserving Surgery
(partial mastectomy + ALND)
Tumor smaller without the followings:
1.Multifoci in the same breast
2.Diffuse microcalcification on mammogram
3.Involvement of nipple or just beneath nipple / areola
4.Small breast
5.Tumor recurrence after previous conserving surgery
6.Radiotherapy cannot be performed due to patients’
will or shortage of facility, Ex. Pregnancy, Collagen
vascular disease….
23
33. SOP of Sentinel Lymph Node Biopsy
33
Candidate for sentinel lymph node biopsy
( stage I/II/III. Clinically node negative)
Isotope injection before admission
or >2 hour before op, subareolar
Blue dye injection (2-3ml) in OR,
5-10min before incision, subareolar
harvest LN, send to frozen section
Axillary LN dissectionNo more ALND
benign metastasis (micro / macro)
Tc-99m, 0.5-1mCi
34. Benefit of Sentinel Node Biopsy
Decreased Morbidity
avoid :
• general anesthesia
• acute and chronic
lymphedema
• nerve damage
• infection
• large scar
• drain placement
Cost savings
• outpatient basis
• local anesthesia
• decreased
complications or
repeat
hospitalizations
• earlier return to work
34
35. Benefit of Sentinel Node Biopsy
Improved Staging
• More thorough pathologic
exam of 1-3 nodes than
15-30 nodes
• Exam may now include
multiple sections,
immunohistochemistry, or
RT-PCR
35
