ACR says BI-RADS criteria may lead to unnecessary pediatric procedures
The American College of Radiology is cautioning clinicians against using the Breast Imaging Reporting and Data System (BI-RADS) to guide the evaluation and management of most breast masses in pediatric care.
Such masses are uncommon in children and adolescents, and the vast majority are benign. In new guidance, the ACR emphasized that BI-RADS was developed for adult breast imaging and may not accurately reflect the risk profile of pediatric breast masses. Applying adult risk categories to this population could overestimate the likelihood of malignancy and prompt avoidable biopsies or other interventions.
“Children and adolescents are not simply small adults,” Stamatia Destounis, MD, chair of the ACR Commission on Breast Imaging, said in a news release shared Oct. 14. “Using adult risk assessment tools in young patients may create unnecessary concern and lead to procedures that do not improve care.”
Ultrasound remains the preferred imaging modality for evaluating breast masses in pediatric patients, according to the college, while mammography generally is discouraged this population because of developing breast tissue and its limited benefit. The guidance encourages providers to base management decisions on pediatric-specific clinical findings, imaging characteristics and established best practices rather than relying on BI-RADS categories designed for adults.
The recommendation reflects the importance of tailoring imaging assessment to the patient population. Because breast cancer is extremely rare in children and adolescents, an approach that appropriately accounts for the low likelihood of malignancy may help avoid unnecessary interventions while supporting appropriate evaluation and follow-up.
For radiologists, the guidance underscores the need to distinguish pediatric breast imaging from adult protocols and to consider the potential consequences of applying adult risk assessment tools to younger patients.
The new guidance can be found here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.