The lesion is actually not much bigger than in 2009. Can you call this lesion anything else than Birads IV seeing it is not any larger?
No. Once it is Birads IV it stays Birads IV until you have a histological diagnosis. The fact that the lesion has not grown means nothing in the context of the Birads classification. Do not be tempted to downgrade this lesion because it has not grown.
The same lesion two years later. The patient was lost to follow up and she is now 19 years old.
The reader again makes reference to the atypical appearance and reiterates the previous recommendation for sampling. Birads IV.