 Hello everyone, welcome to IndianRadiologist.com. I am Dr. Shanti Shetty and I am doing this section on mammography. Today I will be doing a quick video on Byritz 5 lesions, the ultrasound and mammography appearance. Byritz 5 category includes breast masses which are highly suspicious of malignancy. These lesions have more than 95% chance of turning out to be malignant. These patients usually present with a palpable hard lump which is picked up generally on self-examination or by the physician on a routine breast examination. So what is the characteristic appearance of these lesions on a mammogram and on ultrasound? On a mammogram if you see a high density speculated mass with irregular margins or a irregular speculated mass with pleomorphic calcification or segmental or linear arrangement of linear calcifications then you should think of a Byritz 5 lesion. On ultrasound they appear usually as hypoechoic mass lesions with irregular ill-defined margins. Calcification may or may not be seen. Vascularity may be seen in most cases. Associated significant lymphedinopathy may also be seen. Malignant breast masses are classified into six types. Invasive ductal carcinoma, invasive lobular carcinoma, tubular carcinoma, medullary carcinoma, mucinous or colloid carcinoma, and intracistic papillary or invasive papillary carcinoma. Invasive ductal carcinoma is the most common type of breast malignancy. It is a high density irregular mass with indistinct or speculated margins. Spot compression views may reveal partially indistinct margins in some cases. 40% of these masses are associated with calcifications. The second type which is the invasive lobular carcinoma presents as an irregular equal density mass with indistinct or speculated margins, asymmetry or architectural distortion on mammograms. It is often a cult on a mammogram. The third type which is tubular carcinoma is a slow growing tumor. They usually small when detected on mammograms appearing as an irregular speculated high density mass. The fourth variety is a medullary carcinoma which is most commonly seen in younger women. They present as a benign mass on mammogram showing features such as oval shape and circumscribed margins. Ultrasound may show intralesional fluid. These apparently benign features can delay the diagnosis of these masses. The fifth variety which is the mucinous carcinoma or colloid carcinoma are seen in older women. These cancers do show benign imaging features such as oval shape, circumscribed margins and posterior acoustic enhancement on ultrasound. The sixth variety is the intracistic papillary cancer or invasive papillary cancer. These are uncommon breast malignancies which are often large conglomerate masses. On mammograms they appear circumscribed with solid and cystic components seen on ultrasound. If the tumor is entirely intracistic then it has an excellent prognosis.