Jeffrey L Koning1, Katherine P Davenport2, Patricia S Poole3, Peter G Kruk4, Julia E Grabowski5. 1. Department of Radiology, University of California San Diego, 200 West Arbor Drive MC 8756, San Diego, CA 92103-8756, United States. Electronic address: jlkoning@ucsd.edu. 2. Division of Pediatric Surgery, Rady Children's Hospital, 3020 Children's Way MC 5136, San Diego, CA 92123, United States. Electronic address: kdavenport@rchsd.org. 3. Division of Women's Imaging, San Diego Imaging Medical Group, 7910 Frost Street Suite 100, San Diego, CA 92123, United States. Electronic address: Patricia.Poole@sandiegoimaging.com. 4. Department of Radiology, University of California San Diego, 200 West Arbor Drive MC 8756, San Diego, CA 92103-8756, United States; Department of Radiology, Rady Children's Hospital, 8001 Frost Street, San Diego, CA 92123, United States. Electronic address: pkruk@rchsd.org. 5. Division of Pediatric Surgery, Rady Children's Hospital, 3020 Children's Way MC 5136, San Diego, CA 92123, United States; Department of Surgery, University of California San Diego, 200 West Arbor Drive, San Diego, CA 92103, United States. Electronic address: jgrabowski@rchsd.org.
Abstract
INTRODUCTION: The American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) classification was developed to risk stratify breast lesions and guide surgical management based on imaging. Previous studies validating BI-RADS for US do not include pediatric patients. Most pediatric breast masses present as palpable lesions and frequently undergo ultrasound, which is often accompanied with a BI-RADS classification. Our study aimed to correlate BI-RADS with pathology findings to assess applicability of the classification system to pediatric patients. METHODS: We performed a retrospective review of all patients who underwent excision of a breast mass at a single center from July 2010 to November 2013. We identified all patients who underwent preoperative ultrasound with BI-RADS classification. Demographic data, imaging results, and surgical pathology were analyzed and correlated. RESULTS: A total of 119 palpable masses were excised from 105 pediatric patients during the study period. Of 119 masses, 81 had preoperative ultrasound, and BI-RADS categories were given to 51 masses. Of these 51, all patients were female and the average age was 15.9 years. BI-RADS 4 was given to 25 of 51 masses (49%), and 100% of these lesions had benign pathology, the most common being fibroadenoma. CONCLUSIONS: Treatment algorithm based on BI-RADS classification may not be valid in pediatric patients. In this study, all patients with a BI-RADS 4 lesion had benign pathology. BI-RADS classification may overstate the risk of malignancy or need for biopsy in this population. Further validation of BI-RADS classification with large scale studies is needed in pediatric and adolescent patients.
INTRODUCTION: The American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) classification was developed to risk stratify breast lesions and guide surgical management based on imaging. Previous studies validating BI-RADS for US do not include pediatric patients. Most pediatric breast masses present as palpable lesions and frequently undergo ultrasound, which is often accompanied with a BI-RADS classification. Our study aimed to correlate BI-RADS with pathology findings to assess applicability of the classification system to pediatric patients. METHODS: We performed a retrospective review of all patients who underwent excision of a breast mass at a single center from July 2010 to November 2013. We identified all patients who underwent preoperative ultrasound with BI-RADS classification. Demographic data, imaging results, and surgical pathology were analyzed and correlated. RESULTS: A total of 119 palpable masses were excised from 105 pediatric patients during the study period. Of 119 masses, 81 had preoperative ultrasound, and BI-RADS categories were given to 51 masses. Of these 51, all patients were female and the average age was 15.9 years. BI-RADS 4 was given to 25 of 51 masses (49%), and 100% of these lesions had benign pathology, the most common being fibroadenoma. CONCLUSIONS: Treatment algorithm based on BI-RADS classification may not be valid in pediatric patients. In this study, all patients with a BI-RADS 4 lesion had benign pathology. BI-RADS classification may overstate the risk of malignancy or need for biopsy in this population. Further validation of BI-RADS classification with large scale studies is needed in pediatric and adolescent patients.