When is a breast tumor biopsy needed?

I had a health check and found a BIRADS 2 breast tumor. Do I need a biopsy to confirm whether the tumor is benign or malignant? (Nguyen Hien, 43 years old, Quang Ngai)

Reply:

BIRADS (Breast Imaging Reporting And Data System) is a classification measure to encode breast lesions according to the level and risk of malignancy, based on breast imaging diagnostic means such as ultrasound, X-ray, MRI.

There are 5 levels according to BIRADS. Of which, BIRADS 2 is a group of benign lesions, including benign calcifications, oil cysts, lipomas, mixed density tumors or lymph nodes in the chest... The probability of cancer in this case is 0%.

Lesions classified as BIRADS 2 are benign, with no risk of cancer, so in most cases no treatment is needed, only regular monitoring according to general recommendations. However, large benign tumors that cause pain, breast deformity, loss of confidence, or breast cysts with infectious complications... are often indicated for surgery. The doctor will clearly advise the advantages and disadvantages of treatment methods for the patient to choose.

BIRADS level 0, mammogram is not complete and clear. The patient needs additional localized or magnified mammogram, ultrasound... Based on the new results, the doctor compares with previous images to see if the lesion has changed over time.

Breast cancer screening mammography at Tam Anh General Hospital, Ho Chi Minh City. Photo: Nguyen Tram

BIRADS 1 means that the mammogram results are normal, with no benign or malignant lesions, and both breasts have equal density. Women should continue to have annual breast cancer screening, especially women aged 40 and over.

BIRADS 3 shows a lesion in the chest, the risk of cancer is less than 2%. The patient is advised to return for a check-up within 6 months to closely monitor the tumor or have the lesion biopsied immediately to confirm whether it is benign or malignant.

With BIRADS 4, the lesion is suspected of malignancy, with a 2-95% chance of cancer. The doctor will biopsy, which means examining a small tissue sample, to accurately conclude the condition.

With a BIRADS 5 result, the patient has a very high chance of having breast cancer, at least 95%. Patients are often prescribed a biopsy to make a conclusion and treatment method. With a BIRADS 6 level confirming breast cancer and having a previous biopsy result, the doctor prescribes treatment methods such as chemotherapy, surgery or radiation therapy.

Your tumor is at BIRADS 2 level and does not require a biopsy, however, you should monitor and have regular breast exams to detect abnormalities (if any).

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

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