OBJECTIVE: To evaluate the positive predictive value for BI-RADS (Breast Imaging Reporting and Data System) categories 3, 4 and 5, correlating mammographic and histological diagnosis in non-palpable breast lesions. MATERIALS AND METHODS: Analytical-descriptive study of 169 women submitted to stereotactic localization for surgical biopsy of non-palpable breast lesions. Mammographic and histological findings were correlated, analyzing the predictive positive value for each category. RESULTS: Forty-two (24.8%) cases were diagnosed with breast cancer - only one in category 3, 19 in category 4, and 22 in category 5. The positive predictive value for categories 3, 4A, 4B, 4C and 5 were, respectively, 3.4%, 10.3%, 11.3%, 36% and 91.7%. Microcalcifications were the most frequent finding related to malignancy, present in 61.5% of these cases. CONCLUSION: The present study has demonstrated that BI-RADS allows a safe prediction of high suspicion of malignancy in lesions category 5 and low suspicion for category 3. As regards the category 4, the positive predictive value has shown a progressive increase in subcategories A, B and C, demonstrating that this subclassification represents an invaluable contribution for a more detailed and accurate assessment of lesions suspicious for malignancy.401911Bellantone, R., Rossi, S., Lombardi, C.P., Nonpalpable lesions of the breast. Diagnostic and therapeutic considerations (1994) Minerva Chir, 49, pp. 327-333Frasson, A., Farante, G., Sacchini, V., Localização pré-operatória de lesões mamárias não-palpáveis (1993) Rev Bras Ginecol Obstet, 3, pp. 35-44Hall, F.M., Storella, J.M., Silverstone, D.M., Wyshak, G., Nonpalpable breast lesions: Recommendations for biopsy based on suspicion of carcinoma at mammography (1988) Radiology, 167, pp. 353-358Orel, S.G., Kay, N., Reynolds, C., Sullivan, D.C., BIRADS categorization as a predictor of malignancy (1999) Radiology, 211, pp. 845-850D'Orsi, C.J., (2003) Illustrated Breast Imaging Reporting and Data System, , 4th ed. Reston: American College of RadiologyRocha DC, Bauab SP. Atlas de imagem da mama. Correlação mamografia/ultra-sonografia, incluindo ressonância magnética e BI-RADS. 2a ed. Rio de Janeiro: Revinter, 2004Liberman, L., Abramson, A.F., Squires, F.B., Glassman, J.R., Morris, E.A., Dershaw, D.D., The Breast Imaging Reporting and Data System: Positive predictive value of mammographic features and final assessment categories (1998) AJR Am J Roentgenol, 171, pp. 35-40Bérubé, M., Curpen, B., Ugolini, P., Level of suspicion of mammographic lesion: Use of features defined by BI-RADS lexicon and correlation with large-core breast biopsy (1998) Can Assoc Radiol J, 49, pp. 223-228Vieira, A.V., Toigo, F.T., Classificação BI-RADS: Categorização de 4.968 mamografias (2002) Radiol Bras, 35, pp. 205-208Kestelman, F.P., Canella, E.O., Arvellos, N.A., Classificação radiológica nas lesões não-palpáveis da mama. Análise de resultados do Hospital do Câncer III - INCA-MS (2001) Radiol Bras, 34 (SUPL 1), p. 20Giannotti, I.A., Giannotti Filho, O., Scalzaretto, A.P., Visentainer, M., Elias, S., Correlação entre diagnóstico por imagem e histologia de lesões não-palpáveis de mama (2003) Rev Bras Cancer, 49, pp. 87-90Roveda Jr, D., Campos, M.S.D.A., Ferezin, P.C., Ferreira, A.C.P., Valle, M.J.R., Valor preditivo das anormalidades mamográficas pelo sistema BI-RADS na ausência de lesões palpáveis das mamas (2001) Radiol Bras, 34 (SUPL 1), p. 21Heywang-Köbrunner SH, Schreer I, Dershaw DD, et al. Mama: diagnóstico por imagem. Correlação entre mamografia, ultra-sonografia, ressonância magnética, tomografia computadorizada e procedimentos intervencionistas. 1a ed. Rio de Janeiro: Revinter, 1999;141-155Stefenon, C.C., Carvalho, A.A., Djahjah, M.C.R., Koch, H.A., Cicatriz radial/lesão esclerosante complexa: Aspectos radiológicos com correlação clínica, ultra-sonográfica e anatomopatológica (2003) Radiol Bras, 36, pp. 95-103