The Applicability of Recommendations Resulting from Ultrasonographic BI-RADS Classification in Adolescent Females

Breast masses can be present in >3% of adolescent patients but are rarely malignant. The American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) is an adult-validated system used to standardize the assessment of breast masses and their appearance on mammography, ultrasound and MRI to risk-stratify these lesions. Masses which are determined to be BI-RADS 4 and above are suspicious for malignancy and recommended for tissue biopsy. BI-RADS has not been validated in adolescents but is often used to assess the appearance of adolescent breast masses on imaging. Multiple small pediatric-specific studies have analyzed breast pathology and concordance with BI-RADS scoring and have found adolescent BI-RADS 4 lesions are essentially universally benign. These studies suggest that the BI-RADS system is inappropriate for breast mass assessment in pediatric and adolescent patients as it over-estimates the rate of malignancy and may lead to unnecessary procedures and anxiety. The primary aim of this study is to assess the performance of BI-RADS reporting in a large multi-institutional cohort. Additional aims are to quantify the rate of malignancy in pediatric breast masses and to retrospectively assess the performance of the APSA Cancer Committee breast mass algorithm.

Consortium PIs: Barrie Rich and Sara Mansfield

Please contact Maddie Peters (Madeline.Peteres@cchmc.org) if you have any questions about how to activate the study at your PSORC site.

Breast mass seen on ultrasound.