Academic Clinical Practice Audit of Imaging for Pediatric Patients Presenting with Breast Symptoms

Author

Lu Mao

Published

December 15, 2024

Statistical analysis

Placeholder for description of statistical methods.

Results

Subject characteristics

Subject demographics and risk factors are summarized by sex and overall in Table 1 below.

Table 1:

Subject demographics and risk factors by sex.
Characteristic Overall, N = 4171 Female, N = 3401 Male, N = 771
Age (years) at imaging 15.4 (13.3, 16.8) 15.6 (13.5, 16.9) 14.8 (12.9, 16.3)
    Unknown 1 1 0
Race


    American Indian or Alaska Native 4 (1.0%) 3 (0.9%) 1 (1.3%)
    Asian 13 (3.1%) 12 (3.5%) 1 (1.3%)
    Black or African American 55 (13%) 46 (14%) 9 (12%)
    Native Hawaiian or Other Pacific Islander 2 (0.5%) 2 (0.6%) 0 (0%)
    White 325 (78%) 265 (78%) 60 (78%)
    Other 18 (4.3%) 12 (3.5%) 6 (7.8%)
Ehtnicity


    Not Hispanic or Latino 359 (86%) 292 (86%) 67 (87%)
    Hispanic or Latino 55 (13%) 46 (14%) 9 (12%)
    Unknown 3 (0.7%) 2 (0.6%) 1 (1.3%)
Pubertal status


    Prepubertal 53 (13%) 43 (13%) 10 (13%)
    Postpubertal 230 (55%) 208 (61%) 22 (29%)
    Unknown 134 (32%) 89 (26%) 45 (58%)
Family history of breast cancer


    Yes 114 (27%) 98 (29%) 16 (21%)
    No 255 (61%) 214 (63%) 41 (53%)
    Unknown 48 (12%) 28 (8.2%) 20 (26%)
Personal history of cancer


    Yes 2 (0.5%) 0 (0%) 2 (2.6%)
    No 369 (88%) 312 (92%) 57 (74%)
    Unknown 46 (11%) 28 (8.2%) 18 (23%)
Recent surgery or trauma? 5 (1.2%) 4 (1.2%) 1 (1.3%)
1 Median (IQR); n (%)

Note

  • Subject id 398 has missing value for breast_us_age_at_scan and mg_age_scan (also missing mri_age_at_scan).

BIRADS 3: Imaging recommendations/adherence

There are 81 BI-RADS 3 assessments on 80 unique patients (subject_number == 132 had 2 exams). One had both ultrasound and mammogram, while the rest had only ultrasound. Imaging follow-up recommendations and adherence (“Yes” in follow_up, second_followup_yes_no, or third_followup_yes_no) are summarized in the table below.

Table 2:

Imaging follow-up recommendations and adherence for BI-RADS 3 assessments.
Characteristic N = 811 95% CI2
Follow-up recommendation 77 (95.1%) 87.2%, 98.4%
Follow-up adherence 57 (70.4%) 59.0%, 79.7%
1 n (%)
2 CI = Confidence Interval

Recommendation rates overall

Table 3:

Imaging recommendations for mammogram and ultrasound exams.
Characteristic All Mammogram US-v1 US-v2 US-v3
N = 4391 95% CI2 N = 101 N = 4171 N = 101 N = 21
None/General clinical follow-up 296 (67.4%) 62.8%, 71.8% 9 (90.0%) 280 (67.1%) 6 (60.0%) 1 (50.0%)
Imaging follow-up 99 (22.6%) 18.8%, 26.8% 1 (10.0%) 95 (22.8%) 2 (20.0%) 1 (50.0%)
Biopsy 34 (7.7%) 5.50%, 10.8% 0 (0.0%) 34 (8.2%) 0 (0.0%) 0 (0.0%)
Aspiration 15 (3.4%) 1.99%, 5.70% 0 (0.0%) 13 (3.1%) 1 (10.0%) 1 (50.0%)
Surgical consultation 22 (5.0%) 3.24%, 7.60% 0 (0.0%) 21 (5.0%) 1 (10.0%) 0 (0.0%)
1 n (%)
2 CI = Confidence Interval

Note:

  • Exams are included if bi_rads_assessment_** is not missing;
  • There may be more than one recommendation per exam (categories not mutually exclusive).

Diagnostic performance of BI-RADS

Overall diagnostic results based on (non-missing) ref_std_imaging_result, ref_std_imaging_result_v2, and ref_std_imaging_result_v2_v2 are tabulated in Table 4 below.

Table 4:

Diagnostic results of BI-RADS assessments.
Characteristic Overall, N = 3241 V1, N = 3151 V2, N = 81 V3, N = 11
Diagnostic Result



    True Positive 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%)
    True Negative 212 (65.4%) 205 (65.1%) 6 (75.0%) 1 (100.0%)
    False Positive 35 (10.8%) 34 (10.8%) 1 (12.5%) 0 (0.0%)
    False Negative 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%)
    Retrospective TN 77 (23.8%) 76 (24.1%) 1 (12.5%) 0 (0.0%)
    Retrospective FP 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%)
1 n (%)

There is no case (malignancy). Specificity (TN/non-case) results are summarized below.

Table 5:

Specificity of BI-RADS assessments.
Characteristic Overall V1 V2 V3
Specificity1 95% CI2 Specificity1 Specificity1 Specificity1
Without Retro 212 / 247 (85.8%) 80.7%, 89.8% 205 / 239 (85.8%) 6 / 7 (85.7%) 1 / 1 (100.0%)
With Retro 289 / 324 (89.2%) 85.2%, 92.3% 281 / 315 (89.2%) 7 / 8 (87.5%) 1 / 1 (100.0%)
1 n / N (%)
2 CI = Confidence Interval

Distribution of breast lesion pathology

Note: Variable names for biopsy and resection results.
biopsy resection
V1 conventional_fibroadenoma breast_lesion_pathology
V2 breast_lesion_pathology_v2 breast_lesion_pathology_resec_v2
V3 breast_lesion_pathology_v3 breast_lesion_pathology_resec_v3

Pathology results from biopsy and resection are summarized in the table below.

Table 6:

Pathology results from biopsy and resection.
Characteristic Overall, N = 631 biopsy, N = 371 resection, N = 261
Pathology


    Conventional fibroadenoma 40 (63%) 25 (68%) 15 (58%)
    Juvenile fibroadenoma 7 (11%) 4 (11%) 3 (12%)
    Tubular adenoma 1 (2%) 0 (0%) 1 (4%)
    PASH 1 (2%) 1 (3%) 0 (0%)
    Other benign lesion 7 (11%) 1 (3%) 6 (23%)
    Unspecified benign 7 (11%) 6 (16%) 1 (4%)
1 n (%)
Note: Subjects with multiple pathology results.
subject_number version type path
84 V1 resection Conventional fibroadenoma
84 V2 biopsy Conventional fibroadenoma
141 V1 biopsy Unspecified benign
141 V1 resection Conventional fibroadenoma
423 V1 resection Juvenile fibroadenoma
423 V2 resection Juvenile fibroadenoma

Indications

Because the sets of indications for US and MM are different, they will be presented separately. Indications for ultrasound exams are summarized in Table 7 below.

Table 7:

Indications for ultrasound exams.
Characteristic Overall, N = 4291 US-v1, N = 4171 US-v2, N = 101 US-v3, N = 21
Palpable lump 334 (78%) 328 (79%) 5 (50%) 1 (50%)
Pain 139 (32%) 132 (32%) 6 (60%) 1 (50%)
Nipple discharge 21 (5%) 18 (4%) 2 (20%) 1 (50%)
Breast enlargement 2 (0%) 2 (0%) 0 (0%) 0 (0%)
Skin changes 2 (0%) 2 (0%) 0 (0%) 0 (0%)
Incidental imaging finding 1 (0%) 1 (0%) 0 (0%) 0 (0%)
Other 33 (8%) 33 (8%) 0 (0%) 0 (0%)
Missing 1 (0%) 1 (0%) 0 (0%) 0 (0%)
Bruising 0 (0%) 0 (0%) 0 (0%) 0 (0%)
Swelling 26 (6%) 25 (6%) 1 (10%) 0 (0%)
Skin dimpling 2 (0%) 2 (0%) 0 (0%) 0 (0%)
Nipple dimpling/inversion 5 (1%) 5 (1%) 0 (0%) 0 (0%)
Erythema 44 (10%) 42 (10%) 2 (20%) 0 (0%)
1 n (%)

Indications for mammogram are summarized in Table 8 below.

Table 8:

Indications for mammogram exams.
Characteristic N = 101
Palpable lump 6 (60%)
Pain 4 (40%)
Nipple discharge 1 (10%)
Skin changes 0 (0%)
Incidental imaging finding 0 (0%)
Current cancer 0 (0%)
Screening - high risk 0 (0%)
Screening - average risk 0 (0%)
Other 4 (40%)
Missing 0 (0%)
Swelling 1 (10%)
1 n (%)