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

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.

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.

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.