Division of Endocrinology, Department of Pediatrics, University of Florida College of Medicine, 1701 SW 16th Ave, PO Box 100296, Gainesville, FL 32608, USA.
Pediatrics. 2012 Oct;130(4):e978-81. doi: 10.1542/peds.2011-3122. Epub 2012 Sep 3.
Forensic testimony in alleged child pornography cases commonly asserts that Tanner stage (TS) 4 breast development, characterized by secondary mounding of the areola that is obliterated in TS 5, is evidence of age <18 years. Clinical experience does not support this notion, but there are no relevant studies. We sought to estimate how frequently TS 4 might be interpreted from nonclinical images by individual forensic experts.
Published images of 547 adult women were independently examined by the authors and classified as having TS 4 or TS 5 breast development.
There was concordance among all 4 of the examiners for 17 of the images, agreement of 3 of the examiners on another 36 images, of 2 examiners on 39 images, and 53 images were designated TS 4 by only 1 examiner, for a total of 153 (26.5%) images that could have been considered by a single forensic expert to represent TS 4.
A substantial number of adults have persistent TS 4 breast development. This observation, and the frequent difficulty distinguishing TS 4 from TS 5, even by adolescent development specialists, especially in nonclinical images, renders testimony based on this distinction invalid. Without clinical relevance for distinguishing these advanced stages of breast development, they should both be considered indicative of full maturation. Testimony based on this inappropriate test of maturity should no longer be allowed.
在涉嫌儿童色情案件的法医证词中，通常断言 Tanner 分期（TS）4 期乳房发育，其特征是乳晕的二次隆起，在 TS 5 期乳晕被掩盖，这是年龄<18 岁的证据。临床经验并不支持这一观点，但没有相关研究。我们试图估计个体法医专家通过非临床图像解读 TS 4 期的频率。
作者独立检查了已发表的 547 名成年女性的图像，并将其分类为 TS 4 期或 TS 5 期乳房发育。
在所有 4 名检查者中，有 17 张图像是一致的，3 名检查者对另外 36 张图像，2 名检查者对 39 张图像达成了一致意见，只有 1 名检查者将 53 张图像指定为 TS 4 期，总共 153 张（26.5%）图像可能被单个法医专家认为代表 TS 4 期。
大量成年人存在持续的 TS 4 期乳房发育。这一观察结果，以及即使是青少年发育专家，特别是在非临床图像中，也很难区分 TS 4 期和 TS 5 期，使得基于这种区别的证词无效。在区分这些乳房发育的晚期阶段时，没有临床相关性，因此两者都应被认为是完全成熟的标志。基于这种不成熟测试的证词不应再被允许。
