Many studies, including one by Sickles in 1991 ( 9), demonstrated that if the BI-RADS descriptors are used appropriately, lesions placed in this category have a rate of malignancy lower than 2%. A retrospective study from the Breast Cancer Surveillance Consortium from January 1996 through December 1999 demonstrated even lower rates, with 5.2% of first and 1.7% of subsequent screening examinations having a recommendation for short-interval follow-up ( 8). A later study by Monticciolo et al demonstrated a slight decline in the number of cases (average of 6%) referred for short-term follow-up, with a range of 1.1%–12.2% ( 7). The percentage of screening mammograms that are placed in BI-RADS category 3 has been variably reported, ranging 1.2%–9.8%, with an average of 5%, in one study ( 5), and 1.4%–14%, with an average of 7.7%, in another study ( 6). Also, concern exists that if these lesions change at follow-up and ultimately biopsy is performed, they may have progressed to more advanced stages ( 2). All of these biopsies contribute to the total false-positive rate of mammography. Other lesions undergo biopsy because of referring physician or patient concern that there could be a substantial risk of malignancy ( 3, 4). Even if the lesions meet the descriptors in the BI-RADS classification that would indicate that these lesions are probably benign, many of these lesions are instead recommended for biopsy, as described in an article by Pijnappel et al ( 2), in which the authors depicted this as common practice in England and the Netherlands. The decision to classify some mammographic lesions as Breast Imaging Reporting and Data System (BI-RADS) category 3–probably benign and recommend a short-interval follow-up, usually at 6 months ( 1), continues to be problematic for many radiologists, patients, and referring physicians.
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