ACR Urges Caution When Using BI-RADS for Pediatric Breast Masses

The American College of Radiology® (ACR®) released guidance to clinicians that the Breast Imaging Reporting and Data System (BI-RADS®) was developed for adult breast imaging and should not guide care for most pediatric breast masses.

Breast masses in children and adolescents are uncommon, and the vast majority are benign. Research shows that applying BI-RADS categories to pediatric patients can overestimate the risk of cancer and may lead to unnecessary biopsies or procedures. 

Because breast cancer is extremely rare in children and adolescents, experts recommend a conservative, patient-centered approach. Ultrasound remains the preferred imaging tool for evaluating pediatric breast masses, while mammography is generally not used because of developing breast tissue and limited benefit in this population.

“Children and adolescents are not simply small adults,” said Stamatia Destounis, MD, FACR, chair of the ACR Commission on Breast Imaging. “Using adult risk assessment tools in young patients may create unnecessary concern and lead to procedures that do not improve care.”

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

For more information or to interview a spokesperson, contact ACR Public Affairs.