2024年版乳腺影像学 BI-RADS 更新

The lexicon and illustrations have been updated and expanded with examples primarily from digital mammography(DM), inculding digital breast tomosynthesis (DBT) and synthetic mammogram images(SM). All images have been reviewed and updated.

术语和插图已经更新并扩展了主要来自数字乳腺X线摄影（DM）的示例，包括数字乳腺断层合成（DBT）和合成乳腺X线摄影图像（SM）。所有图片都被审查和更新。

The definition of  screening and diagnostic  examinations edited to include DBT  and its benefits of lower recall rate and higher cancer detection. Added that DBT also allows better visualization of a lesion's margins and improves  the ability to localize lesions within the breast.

筛选和诊断检查的定义编入了包括 DBT  及其低召回率和高癌症检出率的好处。 此外， DBT 还可以更好地显示病变边缘，并提高乳腺内病变定位的能力。

Specifically adding "even" when a  lesion is  seen in only one standard  mammographic projection. And increased conspicuity and localization of lesions with DBT may eliminate the need for additional diagnostic mammographic views.

特别是当病变仅在一个标准乳腺X线摄影投影中可见时，增加“偶合影”一词。DBT 对病变的显著性和定位的提高可能消除了额外的诊断性乳腺 X 线摄影检查的需要。

If the breast  tissue in any region of the mammographic view is dense and potentially masking an underlying cancer, then the  breast density classification is  based on an assessment of the densest region and not the entire breast.

如果乳腺X线摄影上任何区域的乳腺组织致密， 可能掩盖了潜在的癌症， 那么乳腺致密度分类是基于对密度最大的区域的评估，而不是整个乳腺。

Similarly, if each breast falls into different density categories, then the greater density of the two is assigned to that mammogram  examination. Breast density is assigned to  each examination to accurately reflect the current breast density and is updated each time the patient has a mammogram.

同样，如果每个乳腺属于不同的致密度类别，那么两个乳腺中致密度较大的一个被指定 为乳腺X线摄影检查所见的致密度类别。每次检查都指定乳腺致密度类别，以准确反映当前的乳腺致密度类别，并在每次患者进行乳腺 X 线摄影时更新。

Due to the recent (March  2023) FDA legislation (MQSA Final Rule) in relation  to breast density, we will need to ensure that the wording in our reports match the language outlined by FDA: The  breasts are almost entirely fatty; There are scattered areas of fibroglandular density; The breasts  are heterogeneously dense, which may obscure small masses; The breasts are extremely dense, which lowers the sensitivity of mammography.

由于最近（2023 年 3 月）FDA 关于乳腺致密度的立法（MQSA最终规则），我们需要确保我们报告中的措辞与 FDA 叙述的语言相符： 乳腺几乎完全是脂肪；可见散在的纤维腺体密度；乳腺密度不均，可能掩盖小肿块；乳腺非常致密，这降低了乳腺X线摄影的灵敏度。

Breast density is significant for two reasons: mammographic accuracy and breast cancer risk. Impact of breast density on mammographic accuracy is due to the masking effect of dense fibroglandular  tissue and in this context, it is felt to be  perhaps more significant than inherent risk.  Similar to increasing age, genetic mutation, family history, and reproductive history, having dense breasts confers an increased inherent risk for developing breast cancer. Compared to the breasts of women with scattered fibroglandular tissue, the odds ratio of breast cancer is 0.6 for almost  entirely fatty, 1.4 for heterogeneously dense, and 1.6 for extremely dense breasts.

乳腺致密度之所以重要，有两个原因：乳腺X线摄影的准确性和患乳腺癌的风险。乳腺致密度对乳腺X线摄影准确性的影响是由于致密纤维腺体组织的掩盖效应，在这种情况下，它可能比固有风险更重要。与年龄增长、基因突变、家族史和生育史类似，乳腺致密会增加患乳腺癌的内在风险。与散在纤维腺体组织的乳腺相比，几乎完全是脂肪的乳腺的乳腺癌的易发比为0.6，非均匀致密乳腺的易发比为1.4，极度致密乳腺的易发比为1.6。

In response to many radiologists' comments, the shape descriptor  "lobular" has been reinstated. The margin descriptor  microlobulated has been eliminated as it  was used infrequently. Not final as lots of discussion around these descriptors.

为了回应许多放射科医生的评论，形状描述符“分叶的”已经恢复。边缘描述词微分叶已被清除，因为它是不经常使用。关于这些描述符的讨论并不多。

The term "popcorn-like" calcifications  has been removed and replaced by coarse.  Coarse calcifications may be produced by an involuting fibroadenoma and over time may coalesce to become a single very large calcification. There may be some overlap in the appearance of the typically benign descriptor coarse and the suspicious descriptor coarse heterogeneous, but coarse calcifications are typically larger with smoother margins.

“爆米花状”钙化已被去掉，代之以“粗大”钙化。粗大钙化可由退化缩小的纤维腺瘤产生，随着时间的推移可合并成单个的非常大的钙化。典型的良性描述性的粗大钙化和可疑描述性的粗糙不均质钙化在外观上可能有一些重叠，但良性的粗大钙化通常更大，边缘更光滑。

The term "punctate", historically a subset of round calcifications when <0.5mm in size has been removed, given how impractical it is to measure the size of individual calcifications. Now these calcifications reside under the round  calcification descriptor.

考虑到测量单个钙化的大小是不切实际的，“细点状”一词在历史上是当尺寸<0.5mm 时圆形钙化的子集，已被去除。这些钙化位于圆形钙化描述符下。

They are semilunar, crescent shaped,  curvilinear (concave up), or linear on mediolateral oblique (MLO) or 90°lateral (LM/ML) views. On craniocaudal (CC) views they are often less evident and appear as round, smudgy deposits.

此种钙化在内外斜位（MLO）或90度侧位（外内位 LM/内外位 ML）上呈半月形、新月形、曲线状（上凹）或线性。在头尾位（CC）视图上，它们通常不太明显，呈圆形、浑浊沉积。

The developing asymmetry descriptor has been removed to be consistent with the lack of temporal relationships in other aspects of the BI-RADS Atlas. This is a change that is being discussed currently with the subcommittees and external reviewers.

进展性非对称致密描述符已被删除，以与 BI-RADS 图集其他方面缺乏时间关系相一致。这是目前正在与小组委员会和外部审查人员讨论的变化。

Newer literature review confirms prior research that a solitary dilated duct is a rare finding and, when not associated with  suspicious imaging features  such as an associated mass, architectural distortion, or microcalcifications it is benign.

新的文献综述证实了先前的研究：孤立性扩张导管是一种罕见的发现，当没有可疑的影像学特征（如相关肿块、结构扭曲或微钙化）时，它是良性的。

Introduction of new element in associated features: Thick band of echogenic tissue surrounding all or part of a breast mass.

1.Disrupts texture of normal tissue surrounding the mass. 

2.Likely represents desmoplastic reaction or peritumoral edema.

在相关特征中引入新元素：乳腺肿块周围或其局部的厚带回声组织。

1. 环绕肿块周围的正常组织的杂乱质地。

2. 可能代表结缔组织增生反应或肿瘤周围水肿
   

Not Echogenic Rind: This is a smooth pseudocapsule, which we may sure to see with a fibroadenoma.

非回声环：这是平滑的假包膜，确信是纤维腺瘤。

Measurement of mass should include the  echogenic rind. High PPV for malignancy*-->biopsy unless proven benign. Notable exception: fat necrosis.

肿块测量应包括回声环。高 PPV 为恶性* --> 活检，除非证实为良性。值得注意的例外：脂肪坏死。

（* [1]Constantini M, et al. J Ultrasound Med 2006;25:649-659. [2]Watanabe T, et al. J Med Ultrason 2021;48:71-81）

Echogenic Rind 回声环

1. Distinct (and opposite) from echogenic pseudocapsule:

   (1)Uniformly thin.

   (2)Oval shape suggesting benignity. 

2. Less sharply demarcated, thicker, more variable in thickness (mass of any shape). 

3. Inclusion of echogenic rind in measurement of mass (Best correlation with histology).

1. 与假回声包膜区别（假回声包膜表现）：

   (1)均匀薄。

   (2)椭圆形，提示良性。

2. 边界不太明显，较厚，厚度变化较大（任何形状的肿块）。

3.  肿块测量要包含回声环（与组织学最相关）。
   

Given the current advances in US equipment capabilities and knowledge of breast US, there is increasing awareness and identification of abnormalities at US that do not rise to the criteria of a mass.

鉴于目前超声设备能力和乳腺超声知识的进步，人们越来越多地以超声认识和辨别尚未 达到肿块标准的异常。

1. Introduction of new category of sonographic finding. 

2. Lacks the 3-dimensionality of a mass:

   (1)Identifiable in at least 2  planes, but may  be  primarily  visualized in  1  plane only.

   (2)Lacks definable shape and margin for assessment.

   (3)If malignant, histology more likely to be in-situ (versus invasive) carcinoma.

1. 介绍超声检查的新类别。 

2. 缺乏肿块的三维性：

   (1)至少在2个平面上可识别，但可能主要在1个平面上可见。

   (2)缺乏明确的评估形状和边缘。

   (3)如果恶性，组织学上更可能是原位癌（而不是浸润性癌）。

Echogenicity of nonmass: Hypoechoic,isoechoic,hyperechoic,mixed echogenicity.

非肿块回声：低回声、等回声、高回声、混合回声。

Distribution of nonmass: Regional,focal,linear,segmental.

非肿块分布：区域性、局灶性、线状、节段性。

Shape/Margin of nonmass: Not applicable as shape/margin not characterizable.

非肿块的形状/边缘： 形状/边缘不可描述。

Orientation of nonmass: Parallel, antiparallel.

非肿块的排列： 平行、反平行的。

1. Associated imaging variables of nonmass:

   (1)Echogenic rind, architectural distortion, posterior shadowing, hypervascularity, ductal extension or abnormal ductal changes, calcifications suggest malignant.

   (2)Presence of small cysts suggest benign*. 

2. Associated clinical variables of nonmass: Probability of malignancy increases in setting of nipple discharge or palpability.

1.  非肿块相关影像学变量：

   (1)回声环、结构扭曲、后方声影、血管增多、导管扩张或 导管异常改变、钙化提示恶性。

   (2)小囊肿提示为良性* 。

2.  非肿块相关临床变量： 组合 乳头溢液或可触及则增加恶性肿瘤的可能性。

(*Park KW, et al. Eur Radiol 2021;31:1693-1706)

1. Expansion of discussion on lymph nodes.

2. Location:

   (1)Intramammary node.(2)Axillary node(levels I, II,  III).  

   (3)Internal mammary node.

   (4)Supraclavicular node. Morphology:Corticalhilar relationship.

3. Morphology:Corticalhilar relationship.

1. 扩充淋巴结的详细描述。

2. 部位：

   (1)乳腺内淋巴结。

   (2)腋窝淋巴结(I 、II 、III 级)。

   (3)内乳淋巴结。

   (4)锁骨上淋巴结。

3. 形态学：皮质- 门关系。

1. Comparison and correlation with prior breast imaging studies important for interpretation.

2. May not be needed for all MRI exams since features on MRI alone are often sufficient for appropriate assessments and recommendations.

3. Diagnostic:Current breast cancer--comparison to prior imaging studies that lead to cancer diagnosis and/or that last-assessed current cancer whenever possible.

1. 与先前乳腺影像学研究的比较和相关性对解释很重要。

2. 可能不是所有的 MRI 检查都需要，因为 MRI 的特征通常足以进行适当的评估和建议。 

3. 诊断：当前的乳腺癌——只要可能，就要对照先前的影像学研究，这些导致癌症诊断，和/或最后评估当前的癌症。

1. Revised and expanded.

2. Standard "full-protocol" contrast enhanced (Usually at least 2 post-contrast series). 

3. Abbreviated contrast enhanced (Shorter, Typically<10 minutes at least 1 post-contrast series). 

4. "Faster" hybrid techniques with early high temporal series.

1. 修订和扩展。

2. 标准“全协议”对比增强（通常至少2个增强后系列）。

3. 简缩的对比增强（较短，通常小于10分钟，至少1个增强后系列）。

4. 早期高适时系列的“更快”混合技术。

Changed from "initial" to "peak".

改为：由“初始”到“峰值”。

1. Complment to DCE.

2. Research as part o non-contrast screening.

3. No BI-RADS reporting guidelines included at this time(EUSOBI International Consensus Statement referenced*).
   

1. 补充 DCE 。

2. 作为非对比增强筛查的一部分。

3. 目前尚未包括在 BI-RADS 报告指南（参考 EUSOBI 国际共识声明*）。

(*Baltzer P, et al. Eur Radiol 2020)

Removed  from  Lexicon.

1. Almost all tiny dots of enhancement are benign and are appropriately dismissed.

2. For a truly unique enhancing finding ≤5mm,  modern techniques allow characterization/categorization as: 

   (1)Small mass (meets criteria/features of mass). 

   (2)Small focal NME (does not meet criteria/features of mass).

   (3)Heterogeneity in use of "focus" across practices and in literature.

从术语中移除。

1. 几乎所有微小的强化点影都是良性的，可以适当地去除。

2. 对于真正独特的强化发现≤5mm，现代技术允许表征/分类为：

   (1)小肿块（符合肿块标准/特征）。

   (2)小局灶性非肿块强化（不符合肿块标准/特征）。

   (3)实践和文献中“灶点强化”使用缺乏一致性。
   

Shape and Margin descriptors updated.

1.  Shape "lobular" added:

   (1)A few gentle obtuse undulations.

   (2)Included within "oval" in current edition.

   (3)Consistency in updates across modalities.

2. Margin "irregular" changed to "uneven" ("irregular" is a mass shape).
   

形状和边缘描述符更新。

1. 形状添加“分叶的”：

   (1)一些平缓的钝波。

   (2)包含在当前版本的“椭圆”中。

   (3)跨模态更新的一致性。

2. 边缘“不规则”改为“不平整的”（“不规则”是肿块形状）。

Mass: T2W hyperintensity descriptor added. Benign and malignant enhancing masses can be hyperintense on bright fluid (T2W) sequences. A T2W hyperintense mass that is also oval and circumscribed and demonstrates homogeneous internal enhancement or dark internal septations has a low probability of malignancy ≤ 2 %.

肿块： 增加 T2W  高信号描述符。 良恶性增强肿块在亮液序列（T2W）上可表现为高信 号。T2W 高信号肿块，同时也呈椭圆形，边界分明，内部均匀强化或暗内分隔，其恶性概率低，≤2%。

Mass T2W signal intensity:  Categorized as hyperintensity if it is uniformly bright throughout the mass, and as bright as a normal-appearing lymph node.

肿块 T2W 信号强度： 若整个肿块均匀亮，且与正常淋巴结一样亮，则归为高信号。

1. Across modalities.  
   

2. For each modality, the relevant/included nodes.

3. Breast MRI. 

   (1)Intramammary. 

   (2)Axillary.

   (3)Internal mammary.

4. Norma vs. abnormal.

1. 跨模态。

2. 对于每个模态，相关/包含淋巴结。

3. 乳腺 MRI：

   (1)乳房内的。

   (2)腋窝。

   (3)内乳。

4. 正常对不正常。
   

1. Abnormal = subjectively asymmetric in morphology compared to ipsilateral or contralateral nodes: Ipsilateral to current or prior breast cancer. 

2. Asymmetric cortical thickening:

   (1)> 3 mm cortex not applicable. 

   (2)Not validated for MRI = appearance of many normal nodes. 

3. Asymmetric rounding, absence of hila:

   (1)Not sole criteria. 

   (2)No hila = appearance of many small normal nodes.

1. 异常=与同侧或对侧淋巴结相比，主观发现在形态学上不对称（同侧当前或既往有乳腺癌）。

2. 皮质不对称性增厚：

   (1)不适用于>3mm 皮质。

   (2)  MRI 不能确认=出现许多正常淋巴结。

3. 不对称圆鼓鼓地，没有淋巴结门：

   (1)不是唯一的标准。

   (2)无淋巴结门=出现在许多小的正常淋巴结。

For axillary lymph nodes, it is necessary to describe and its significance:

对于腋窝淋巴结，需要描述及其意义：

1. 描述腋窝水平 I-III 。

2. 重要的解剖分期信息。

3. 预后和管理。
   

Assessment Category 3

评价第 3 类

Assessment Category 4 Subdivisions (4A-C)

评价第 4 类及其亚类（4A-C）

Assessment Category 6

评估第 6 类

Additional ipsilateral findings:

Category 4

其他同侧发现：第 4 类

Location of findings:

病变定位：

Auditing and outcomes monitoring

审计和结果监控

Modality neutral BI-RADS Assess ments

模式中立的 BI-RADS 评估

Benign with upgrade potential 

(BWUP)

良性升级潜力