DDSM: Terminology



The terminology used in the DDSM database for breast density and lesion descriptions is borrowed from the American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS®).

Please note that the sections of this web page in the boxes are copied word for word from the ACR BI-RADS® document, copyright 1993. This use complies with the "Exception to Requirement for Express Written Consent" because this use is "for medical research for the improvement of patient care" and each portion "is reproduced in its entirety without modification". Please refer to the BI-RADS® document for more comprehensive descriptions of these terms and their use.

The following is an index of terms:


DENSITY - The breast density can take on a value between 1 and 4. The values should be interpreted using the BI-RADS® definitions indicated below.

A succinct description of the overall breast composition.

This is an overall assessment of the attenuating tissues in the breast to help indicate the relative possibility that a lesion could be hidden by the normal tissues. Generally, this includes fatty, mixed and dense.

Since mammography cannot detect all breast cancers, physical examination is always a key element of screening. It is important to alert the clinician that in the radiographically dense breast the ability of mammography to detect small cancers is reduced. Although mammography is still useful in these women, the physical examination (which is always important) is increased in importance. The available data do not support the use of mammographic patterns for determining screening frequency (i.e., risk for breast cancer).

For consistency, this should be included for all patients using the following patterns:

1) The breast is almost entirely fat.
2) There are scattered fibroglandular densities that could obscure a lesion on mammography.
3) The breast is heterogeneously dense. This may lower the sensitivity of mammography.
4) The breast tissue is extremely dense, which lowers the sensitivity of mammography.

An implant code should be added as appropriate if an implant is present.

Page 13: Section II. A. 1. BI-RADS®

ASSESSMENT - The assessment can take on a value between 1 and 5. The values should be interpreted using the BI-RADS® definitions indicated below.

Assessment Is Complete - Final Categories

1) Negative (N):
There is nothing to comment on. The breasts are symmetrical and no masses, architectural disturbances or suspicious calcifications are present.

2) Benign Finding- Negative (B):
This is also a negative mammogram, but the interpreter may wish to describe a finding. Involuting, calcified fibroadenomas, multiple secretory calcifications, fat containing lesions such as oil cysts, lipomas, galactoceles, and mixed density hamartomas all have characteristic appearances, and may be labeled with confidence. The interpreter might wish to describe intramammary lymph nodes, implants, etc. while still concluding that there is no mammographic evidence of malignancy.

3) Probably Benign Finding (P) - Short Interval Follow-Up Suggested:
A finding placed in this category should have a high probability of being benign. It is not expected to change over the follow-up interval, but the radiologist would prefer to establish its stability. Data are becomming available that shed light on the efficacy of short interval follow-up. At the present time, most approaches are intuitive. These will likely undergo future modification as more data accrue as to the validity of an approach, the interval required, and the type of findings that should be followed.

4) Suspicious Abnormality (S) - Biopsy Should be Considered:
These are lesions that do not have the characteristic morphologies of breast cancer but have a definite probability of being malignant. The radiologist has sufficient concern to urge a biopsy. If possible, the relevant probabilities should be cited so that the patient and her physician can make the decision on the ultimate course of action.

5) Highly Suggestive of Malignancy (M):
These lesions have a high probability of being cancer. Appropriate action should be taken.
Page 15: Section II. A. 3. b. BI-RADS®

SUBTLETY - The subtlety rating is NOT from the Bi-RADS® standard. The sublety is a subjective impression of the sublety of a lesion by an expert radiologist. It has a value between 1 and 5, where 1 is "subtle" and 5 is "obvious." The sublety value for a lesion may indicate how difficult it is to find the lesion, but this has not been shown.

MASS SHAPE - The mass shape is indicated by either one of the following, or an appropriate combination of the following keywords [ROUND, OVAL, LOBULATED, IRREGULAR, ARCHITECTURAL_DISTORTION].

MASS MARGINS - The mass margin is indicated by either one of the following, or an appropriate combination of the following keywords [CIRCUMSCRIBED, MICROLOBULATED, OBSCURED, ILL_DEFINED, SPICULATED].

CALCIFICATION TYPE - The calcification type is indicated by either one of the following, or an appropriate combination of the following keywords [PUNCTATE, AMORPHOUS, PLEOMORPHIC, ROUND_AND_REGULAR, LUCENT_CENTER, FINE_LINEAR_BRANCHING].

CALCIFICATION DISTRIBUTION- The calcification distribution is indicated by either one of the following, or an appropriate combination of the following keywords [CLUSTERED, LINEAR, SEGMENTAL, REGIONAL, DIFFUSE].


BI-RADS® is a trademark of the American College of Radiology.