ACR issues guidance on imaging pediatric breast masses

The American College of Radiology issued guidance cautioning clinicians against using the Breast Imaging Reporting and Data System to guide care for most pediatric breast masses.

BI-RADS was developed for adult breast imaging, and applying its categories to children and adolescents can overestimate cancer risk and may lead to unnecessary biopsies or procedures, according to the ACR’s Oct. 14 guidance.

Breast masses in children and adolescents are uncommon, and the vast majority are benign. The ACR said breast cancer is extremely rare in these patients and recommended a conservative, patient-centered approach.

Ultrasound remains the preferred imaging tool for evaluating pediatric breast masses. Mammography is generally not used because of developing breast tissue and limited benefit in this population.

The ACR encouraged radiologists and referring physicians to base management decisions on pediatric-specific clinical findings, imaging features and established best practices rather than BI-RADS categories designed for adults.

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