title: Breast Imaging-Reporting and Data System (BI-RADS) classification in 51 excised palpable pediatric breast masses.
abstract: BACKGROUND
  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.
authors.affiliation: 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.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Koning
authors.affiliation: 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.
authors.forename: Katherine P
authors.initials: KP
authors.lastname: Davenport
authors.affiliation: 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.
authors.forename: Patricia S
authors.initials: PS
authors.lastname: Poole
authors.affiliation: 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.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Kruk
authors.affiliation: 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.
authors.forename: Julia E
authors.initials: JE
authors.lastname: Grabowski
mesh_terms: D000293:Adolescent; D000465:Algorithms; D001706:Biopsy; D001943:Breast Neoplasms / Q000145:classification* / Q000000981:diagnostic imaging* / Q000473:pathology; D002648:Child; D005260:Female; D018226:Fibroadenoma / Q000145:classification / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D012189:Retrospective Studies; D016217:Ultrasonography, Mammary; D055815:Young Adult
keywords: BI-RADS; Breast mass; Breast ultrasound; Fibroadenoma; Pediatric radiology