Breast imaging-reporting and data system (BI-RADS) assessment category 5

BI-RADS 5 lesions under the BI-RADS (breast imaging reporting and data system) refer to breast lesions that are highly suspicious for malignancy, requiring appropriate action to be taken (i.e. biopsy and management as appropriate). BI-RADS 5 lesions have the characteristic morphology of breast cancer with a >95% chance of being malignant.

The implication of a BI-RADS 5 finding, in contrast to BIRADS 4, is that if the histology is benign, it should be considered discordant with imaging findings, and lesion excision is still advised.

Radiographic features


A BI-RADS 5 lesion has the typical imaging features of breast malignancy. On a mammogram, any two of the following features are demonstrated:

  • spiculated or irregular mass
  • high density
  • fine linear or linear branching segmental calcifications

Nipple retraction, skin thickening and evidence of interval growth, if present, would support the diagnosis.

Breast imaging and pathology
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Article information

rID: 46172
System: Breast
Tag: refs
Synonyms or Alternate Spellings:
  • BI-RADS 5
  • BIRADS 5
  • BIRADS-V lesion
  • BIRADS 5 lesion

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