Diagnosis and treatment of symptomatic breast masses in the pediatric population

Evaluation of surgically treated breast masses in children

“…In the literature FA comprise 66-76% of all breast masses, 9,10 with the incidence of CF 0.3-1%. [11][12][13] In our study similar to other studies the majority were identified as FA at 63%. For the other 23 patients with no clinical and diagnostic data accessed but with pathological diagnosis, the majority of masses were identified as FA (47%).…”

Analysis of surgically excised breast masses in 119 pediatric patients

“…A% total% of% 135% masses% removed% from% 119% patients% were% reviewed.% 117% (98.3%)% of% the% patients% were% female% and% only% 2% (1.7%)% of% the% patients% were% male% (Table% 1A).% The%pathology%of%the%breast%masses%in%the%2%male%patients%demonstrated%one%case%of% galactocoele%and%one%case%of%ductal%ectasia.%The%average%age%was%15.3%years%old%with% a% range% of% 1.17% to% 19% years.% On% average% patients% presented% after% 25.7% weeks% of% symptoms,%however,%this%was%highly%variable%(Table%1B).%%Mass%size%ranged%between% 0.8%and%13.2%cm%with%an%average%of%3.2%cm.%58%%of%patients%underwent%documented% diagnostic% ultrasound% (Table% 1B).% % The% percent% of% patients% receiving% preWoperative% ultrasound% did% not% change% significantly% over% time% from% 2010% to% 2013% (data% not% shown).% % We% have% published% a% detailed% analysis% of% the% ultrasound% results% of% this% population%separately% [8].%%% Overall,% 48.4%% of% patients% received% some% form% of% initial% workWup% by% their% primary% physician,%including%ultrasound%imaging%and/or%biopsy%(Fig%1A).%Only%two%patients% had% imaging% other% than% ultrasound.% One% patient% had% a% PET/CT% due% to% a% personal% history%of%cancer%and%one%patient%had%a%mammogram%ordered%at%an%outside%hospital.% The%percentage%of%patients%undergoing%an%initial%work%up%prior%to%referral%to%surgery% remained%relatively%constant%throughout%the%study%period.%%Only%31.9%%of%patients% underwent% some% period% of% observation% ordered% by% either% their% primary% medical% doctor%(PMD)%or%by%their%surgeon.%This%number%did%increase%over%the%time%period%of% the%study%with%66.7%%of%patients%receiving%some%period%of%observation%in%2013%(Fig% 1B).% %We% also% analyzed% the% indications% for% surgical% excision% documented% for% each% operative% encounter.% Indications% included% abnormal% imaging% results,% continued% growth% of% mass,% pain,% size% and% patient% anxiety.% The% most% common% indication% for% excision% was% anxiety,% with% 23.5%% of% patients% and% families% requesting% excisional% biopsy.%This%trend%was%more%apparent%in%the%later%years%of%the%study%(Fig%2).% We%next%analyzed%the%pathology%of%the%surgical%specimens.%In%our%series%all%masses% were% benign.% The% most% common% pathologic% diagnosis% was,% as% expected,% fibroadenoma% at% 75.2%% of% masses% (Table% 2).% Other% common% diagnoses% included% juvenille%fibroadenoma,%tubular%adenoma,%pseudoangiomatous%stromal%hyperplasia% (PASH),%supernumary%nipple,%benign%cyst%and%fibrocystic%changes.% % DISCUSSION:! Pediatric% breast% masses% are% very% rare% and% the% vast% majority% are% benign.% While% the% general% recommendation% is% observation% of% nonWsuspicious% lesions,% practice% habits% vary% widely.% Here% we% examined% 119% patients% from% a% single% tertiary% center% who% underwent%surgical%excision%of%breast%masses%during%a%4.5%year%period.%Demographic% analysis%of%our%population%revealed%a%similar%profile%to%other%studies% [9,10],%with%the% majority%of%patients%being%females%in%midWadolescence.%Multiple%studies%have%shown% that% higher% body% mass% index% (BMI)% in% adolescence% has% a% protective% effect% on% both% benign%and%malignant%breast%disease% (7,17,18).%Consistent%with%previous%reports%the% patients% in% our% series% had% an% average% BMI% of% 22.4,% within% the% normal% range.% Ultrasound% is% the% most% common% modality% of% evaluating% breast% masses% in% the% pediatric% population% and% 58%% of% our% study% population% underwent% preWoperative% ultrasound.%%% In%our%series%only%31.9%%of%patients%underwent%some%period%of%observation,%either% recommended% by% their% primary% medi...…”

Breast Masses In Children

“…Management is controversial and varies among institutions. If the sonographic appearance is classic and the lesion does not show rapid growth, short-term follow-up ultrasound can be used to monitor the mass, because most remain static in size or resolve spontaneously (15,1). The number of sonographic examinations of fibroadenomas varied from 2 to 6 (mean = 2.55) in this study and 9 of 11 fibroadenomas remained static in size, while 2 of them resolved spontaneously.…”