1. BIRADS 0: need additional imaging
-Spot compression- put small paddle over spot to spread it out. Good for questionable areas, margin evaulation. Normal tissue spreads out, abnormal masses don't spread out.
-Mag views- good for calcification,
-U/s (if someone is young)
-MRI
-If you think it's category 3+, get a diagnostic mammogram
2. Category 1: negative
3. Category 2: benign finding. 
-Calcified fibroadenomas,
4. Category 3: probably benign- get short interval follow up
-Only can be diagnosed from diagnostic mammogram
-<2% risk of malignancy
-Circumscribed solid mass, round calcifications (NOT spiculated)
-Cannot be this if its a palpable abnormality. 
5. Category 4: suspicious, consider bx
-5-95% risk of cancer
-4A: low risk
-4B: intermediate risk
-4C: high risk
6. Category 5: highly suspicious of cancer, go to bx
->95% risk
-spiculated margins -- BAD sign.
7. Category 6: biopsy proven malignancy 
-Used after diagnosis but before treatment
8. Mammography 
In the US, the recall rates of screening mammography should be 5-12%. In Europe, its usually <2%. In Europe, you have to read 5000 mammograms a year to qualify as a center; in the US, 240.
-No difference in mortality here vs europe.
-In a woman <30 with a palpable mass, start with an ultrasound first, then go to mammogram.
->30 with palpable mass, go to mammography first
9. U/s
-Screening for high risk women with dense breast parenchma
-In someone <30 with a palpable mass, go to u/s
-Palpable mass, if mammogram is (-), always get an u/s sometimes they can be missed
-Bad sign: angulated edges, hypoechoic, acoustic shadowing
-Use same 7 birads categories
10. MRI
-Recommended for mutation carrier or first deg relative of mutation carrier
-Lifetime risk > 20-25%
-Radiation to chest (ie for hodgkins)
-Start age age 30