When is a breast biopsy necessary?

During a health checkup, a grade 2 BIRADS tumor was discovered in my breast. Do I need a biopsy to definitively determine whether it is benign or malignant? (Nguyen Hien, 43 years old, Quang Ngai)

Reply:

BIRADS (Breast Imaging Reporting And Data System) is a classification system that codes breast lesions according to their severity and malignancy risk, based on breast imaging diagnostic tools such as ultrasound, X-ray, and MRI.

There are 5 levels according to BIRADS. BIRADS 2 includes benign lesions such as benign calcifications, oil cysts, lipomas, mixed-density tumors, or lymph nodes in the chest... The probability of cancer in this case is 0%.

BIRADS-2 graded lesions are benign and do not pose a risk of cancer, so most cases do not require treatment, only regular monitoring as recommended. However, large benign tumors that cause pain, breast deformity, loss of self-confidence, or breast cysts with complications such as infection, are usually indicated for surgery. The doctor will clearly explain the advantages and disadvantages of the treatment methods so that the patient can make an informed choice.

BIRADS level 0: Mammogram images are incomplete and unclear. Patients need additional focal or magnified mammograms, ultrasounds, etc. Based on the new results, the doctor compares them with previous images to see if the lesion has changed over time.

Mammography for breast cancer screening at Tam Anh General Hospital, Ho Chi Minh City. Photo: Nguyen Tram — Mammography for breast cancer screening at Tam Anh General Hospital, Ho Chi Minh City. Photo: *Nguyen Tram*

BIRADS 1 means the mammogram results are normal, with no benign or malignant lesions, and both breasts have equal density. Women should continue annual breast cancer screenings, especially women 40 years of age and older.

BIRADS 3 indicates a lesion in the chest, with a cancer risk of less than 2%. The patient is advised to return for a follow-up examination within 6 months for close monitoring of the tumor or to have the lesion biopsied immediately to confirm whether it is benign or malignant.

With BIRADS 4, a lesion is suspected to be malignant, with a 2-95% chance of being cancerous. The doctor will perform a biopsy, which is examining a small sample of tissue, to determine the exact condition.

With a BIRADS score of 5, the patient has a very high probability of breast cancer, at least 95%. A biopsy is usually recommended to determine the diagnosis and treatment plan. A BIRADS score of 6 confirms breast cancer, and if a previous biopsy is already available, the doctor will prescribe treatment such as chemotherapy, surgery, or radiation therapy.

Your tumor is at BIRADS level 2 and does not require a biopsy; however, regular monitoring and breast examinations are recommended to detect any abnormalities (if any).

Master of Science, Doctor Huynh Ba Tan
Breast Surgery Department, Tam Anh General Hospital, Ho Chi Minh City

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