Breast Nodule Smart Manager · Assessment, Follow-up & Treatment Decision — free guideline decision tool

This tool maps the BI-RADS category to malignancy probability and follow-up/biopsy triage, then after diagnosis gives surgery, axillary management, and subtype-based systemic and radiotherapy principles.

BI-RADS category → malignancy probability and biopsy decision. Diagnosed → breast-conserving + RT vs mastectomy, SLNB (Z0011/AMAROS) vs dissection, and subtype-driven systemic therapy (endocrine/anti-HER2/chemo ± immunotherapy).

Use to triage imaging findings (1–2 routine, 3 short-term follow-up, 4–5 biopsy, 6 diagnosed) and, once a subtype is known, to outline treatment principles.

Breast conservation with whole-breast radiotherapy is survival-equivalent to mastectomy when eligibility criteria are met. (original synthesis · not guideline verbatim) Larger HER2+ or triple-negative tumors, or node-positive disease, favor neoadjuvant therapy before surgery. BI-RADS is an imaging probability, not a diagnosis — biopsy pathology remains the gold standard.

For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.

Inputs: BI-RADS category (ultrasound/mammography) 0 incomplete assessment, Maximum nodule diameter 15 mm, Molecular subtype (if diagnosed) Undiagnosed/unknown, Tumor stage cT (if diagnosed) Unknown, Regional nodes cN (if diagnosed) Unknown → Result: Conclusion BI-RADS 0 (incomplete assessment) · short-term follow-up（(1) Assessment & follow-up: BI-RADS 0 (incomplete assessment) (malignancy probability pending). Needs additional imaging (add mammography/ultrasound/MRI if needed or compare with prior films) before grading; cannot be managed on this basis., Note: If malignancy is already biopsy-confirmed, selecting a molecular subtype and stage can continue to give surgical and radiotherapy/chemotherapy principles., Basis: ACR BI-RADS (5th edition); NCCN breast cancer, CSCO breast cancer guidelines; St. Gallen consensus; KEYNOTE-522; ACOSOG Z0011/AMAROS.） Inputs: BI-RADS category (ultrasound/mammography) 6 biopsy-proven malignancy, Maximum nodule diameter 15 mm, Molecular subtype (if diagnosed) Triple-negative TNBC, Tumor stage cT (if diagnosed) T4 invading chest wall/skin, Regional nodes cN (if diagnosed) cN+ positive → Result: Conclusion BI-RADS 6 (biopsy-proven malignancy) · treatment decision（(1) Assessment & follow-up: BI-RADS 6 (biopsy-proven malignancy) (malignancy probability diagnosed). Pathology confirmed, proceed to staging and treatment., (2) Surgery: Local: if eligible (unifocal, suitable tumor/breast ratio, negative margins achievable, no radiotherapy contraindication) breast-conserving surgery + whole-breast radiotherapy preferred (survival-equivalent to mastectomy); otherwise mastectomy ± reconstruction. Axilla: cN0 sentinel lymph-node biopsy (SLNB), low-burden sentinel-positive may avoid axillary dissection per Z0011/AMAROS or substitute axillary radiotherapy; cN+/multiple positive sentinels → axillary lymph-node dissection. This case has a larger tumor or positive nodes and is HER2+/triple-negative → neoadjuvant therapy first, then surgery (downstaging, enabling breast conservation and pCR assessment)., (3) Radiotherapy/chemotherapy & systemic principles: Triple-negative (TNBC): chemotherapy-based (anthracycline + taxane ± platinum); stage II–III neoadjuvant combined with pembrolizumab (KEYNOTE-522); olaparib for BRCA mutation. Radiotherapy: whole-breast radiotherapy after breast conservation (often hypofractionated); after mastectomy, T3–4 or node-positive need chest-wall + regional nodal radiotherapy.）