Breast Imaging Reporting and Data Sys st pathology identified in breast imaging which is classified into seven categories (0-6) of which category 4 covers a wide range of likelihood of malignancy in between from 2-95% likelihood of malignancy. To improve clinical audits, category 4 is sub-categorized into 4A, 4B, and 4C categories. The positive predictive value for malignancies of BI-RADS 4B and 4C lesions in correlation with pathological diagnosis. This was a retrospective study conducted from June to May 2021 in the Integrated Breast Care Centre (IBCC) in AIIMS, Rishikesh, India. A total of 77 patients were classified as BI-RADS 4B and 4C lesions, 33 were classified as BI-RADS 4B, and 4C as BI-RADS 4C sub-categories.