Radiological BI-RADS Scoring and Histopathological Results: Correlation and Pitfalls
1Department of Pathology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkiye
2Department of Radiology, University of Health Sciences, Bağcılar Training and Research Hospital, Istanbul, Turkiye
3Department of Pathology, Ceylanpinar State Hospital, Sanlıurfa, Türkiye
4Department of Pathology, University of Health Sciences, Gaziosmanpasa Training and Research Hospital, Istanbul, Turkiye
5Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, USA
6Department of Pathology, University of Health Sciences, Istanbul Training and Research Hospital, Istanbul, Turkiye
7Department of Pathology, University of Health Sciences, Bagcilar Training and Research Hospital, Istanbul, Turkiye
Eur Arch Med Res 2026; 42(2): 139-147 DOI: 10.14744/eamr.2025.08216
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Abstract

Objective: The Breast Imaging Reporting and Data System (BI-RADS) is an internationally utilized radiological reporting system for the classification of breast lesions, categorizing cases based on increasing malignancy rates. Given that breast cancer is the most common type of cancer among women and that early diagnosis and treatment are of paramount importance, the correlation between histomorphological changes and the BI-RADS scoring system holds critical significance. In this study, we aimed to evaluate the histopathological correlation with the BI-RADS scoring system and identify potential diagnostic pitfalls.
Materials and
Methods: The radiological findings from breast imaging of 881 women over the age of 40 were retrospectively reviewed and reclassified according to the updated BI-RADS scoring system. The classifications were then correlated with the histopathological results of the biopsies.

Results: In our study, the positive predictive values for detecting malignancy increased progressively from BI-RADS category 4A to 4C, with rates of 6.2%, 34.3%, and 85.7%, respectively. This rate further increased to 94% in category 5.

Conclusion: Although the BI-RADS scoring system, which is effectively used in breast biopsies today, demonstrates a high radiological and pathological correlation, new and innovative studies focusing on subtypes within category 3 and category 4 will contribute to reducing discrepancies observed in these categories.