The Breast Imaging Reporting and Data System (BI-RADS) was developed by the American College of Radiology (ACR) to systematize the format of a mammography report with extension to breast ultrasound and MRI interpretation as well. BI-RADS utilization for standardized reporting helps to manage decision making and serves as a useful tool in collecting data and auditing individual practices. The BI-RADS final assessment categories standardize the reporting of mammographic findings and the recommendations for further management Assessments are either incomplete (category 0) or final assessment categories (categories 1 through 6). A breast mass, also known as a breast lump, is a localized swelling that feel different from the surrounding tissue. Breast pain, nipple discharge, or skin changes may be present. Concerning findings include masses that are hard, do not move easily, are of an irregular shape, or are firmly attached to surrounding tissue. Causes include fibrocystic change, fibroadenomas, breast infection, galactoceles, and breast cancer. Breast cancer makes up about 10% of breast masses. Diagnosis is typically by examination, medical imaging, and tissue biopsy. Tissue biopsy is often by fine needle aspiration biopsy. Repeated examination may be required. Ultrasonography (US) and mammography are the two basic imaging techniques for routine diagnostic imaging of breast diseases. For women over the age of 35 years presenting with a palpable or suspected breast mass, mammography is often the first imaging investigation to be performed. The BI-RADS 5 assessment category is used when the likelihood of malignancy is estimated to be greater than or equal to 95% on the basis of imaging findings. However, according to Yao et al, the actual positive predictive value for a BI-RADS 5 assessment ranges from 78% to 97.5%. Hence, not all BI-RADS 5 lesions are malignant. There are several benign entities affecting the breast that may manifest with highly suspicious imaging features and BI-RADS 5 categorization.