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The Utility of the BIRADS Classification System in Evaluating Breast Masses in the Pediatric and Adolescent Populations

  • Pediatric Surgery (A. Fischer, Section Editor)
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Abstract

Purpose of Review

The American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) is a classification system developed for mammography, ultrasound, and MRI of the breast to provide standardization of breast imaging terminology, reporting, and assessment. The utility of the BI-RADS classification was developed for the adult population to standardize the management of abnormal radiographic findings. Here, we review the literature on the application and utility of the BI-RADS classification system in the pediatric population.

Recent Findings

Five retrospective studies utilized the BI-RADS classification in pediatric breast mass evaluation. Patients’ ages ranged from 10 to 21, with an average age approaching 16. All studies found 100% benign lesions except one case with a BI-RADS-5, which revealed borderline phyllodes tumor on final pathology. The most common pathology noted in all five studies was a fibroadenoma. Two additional studies investigated pediatric breast mass excisional biopsy indicated by abnormal imaging, change in mass size, or patient/family preference secondary to anxiety. Both studies demonstrated all lesions excised revealed benign pathology. In one of the studies, no distinction was made between fibroadenoma and phyllodes. Follow-up revealed no cases of recurrence.

Summary

Using BI-RADS classifications in the pediatric population overestimates the risk of malignancy and leads to unnecessary invasive procedures. For all the studies reviewed, the final pathology demonstrated benign fibroadenoma in 100% of the cases for all BI-RADS classifications. These findings suggest that a pediatric-specific breast imaging classification system would be beneficial to prevent potentially unnecessary invasive interventions in this population.

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Figure. 1

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Authors and Affiliations

  1. Ascension St John Hospital, 22101 Moross Rd, Detroit, MI, 48236, USA

    Nisha Korakavi & Natalie Rizk

  2. West Virginia School of Osteopathic Medicine, 401 Lee St, Lewisburg, WV, 24901, USA

    Logan Smith

  3. Department of Radiology, Johns Hopkins University, 600 N. Wolfe Street, Baltimore, MD, 21287, USA

    Michael Rizk

  4. Palm Beach, Children’s Surgical Specialists, 927 45th Street, Suit 301, West Palm Beach, 33407, USA

    Anne Fischer

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  1. Nisha Korakavi
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  2. Logan Smith
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  4. Anne Fischer
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  5. Natalie Rizk
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Contributions

N.K., L.S, and N.R. all contributed to writing the manuscript. M.R. and L.S. contributed to creation of figures and tables. All authors contributed to editing and reviewing the manuscript.

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Correspondence to Natalie Rizk.

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Korakavi, N., Smith, L., Rizk, M. et al. The Utility of the BIRADS Classification System in Evaluating Breast Masses in the Pediatric and Adolescent Populations. Curr Surg Rep (2024). https://doi.org/10.1007/s40137-024-00407-x

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