Purpose or Case Report: The purpose of this exhibition is to outline practice patterns among breast imaging in the pediatric population while identifying barriers to execution of standard breast imaging practices in pediatric patients.
Methods & Materials: All breast ultrasounds in patients aged 18 years or younger performed at our facility (n = 1214, 1037 female and 178 male) over the preceding 4 year period were reviewed following removal of identifiable information. All reports were studied with respect to class (inpatient, outpatient, or emergency), patient age, sex, indication, findings, recommendations, reporting verbiage, and recommendations.
Results: Of the 1214, exams, 914 (75%) were ordered in the outpatient setting. Imaging features of breast buds were described in 158 patients (13%). A diagnosis of gynecomastia was assigned to 66 male (37%) patients. BI-RADS designations were assigned in 28 examinations (2%) with 11 of these denoted as BI-RADS 1, 1 as BI-RADS 2, and 18 as BI-RADS 3 with most BI-RADS 3 lesions showing characteristics of fibroadenoma. No designations of BI-RADS 4 or BI-RADS 5 were applied. A diagnosis of fibroadenoma was provided in 198 (16%) of the reports with 6 of these lesions assigned a notation that Pseudoangiomatous stromal hyperplasia (PASH) cannot be excluded. Biopsy was discussed in 20 cases (1.6%), all of which in reference to previously diagnosed or probable fibroadenomas. Lymph nodes were described in 37 (3%) of ultrasounds. In 26 impressions (2%), follow-up at designated women's imaging centers was recommended, however, follow-up at such centers proved to be difficult given payment models for pediatric patients and differences in preferences among surgeons and referring clinicians.
Conclusions: Breast ultrasounds in the pediatric population rarely show concerning features, nonetheless, pediatric radiologists are often faced with making recommendations regarding breast findings in children. Despite the availability of BI-RADS designations for breast ultrasounds, pediatric radiologists do not frequently assign them. Reasons for this may include a lack of a reimbursable follow-up mechanism, inability of designated women's imaging centers to accommodate pediatric patients, and conflicting practice habits of pediatric surgeons. Given the high likelihood of benignity in the pediatric population, further study is suggested to define distinct practice parameters for pediatric breast imaging.