- •Most pediatric and adolescent breast masses are benign.
- •The most common reasons for pediatric lumpectomy are lesion size and growth.
- •BI-RADS classification may not be useful in evaluation of pediatric breast masses.
- •It is safe to monitor most breast masses for growth prior to surgical excision.
The objective of our study was to describe the workup, management, and outcomes of pediatric patients with breast masses undergoing operative intervention.
Materials and methods
A retrospective cohort study was conducted of girls 10-21 y of age who underwent surgery for a breast mass across 11 children's hospitals from 2011 to 2016. Demographic and clinical characteristics were summarized.
Four hundred and fifty-three female patients with a median age of 16 y (IQR: 3) underwent surgery for a breast mass during the study period. The most common preoperative imaging was breast ultrasound (95%); 28% reported the Breast Imaging Reporting and Data System (BI-RADS) classification. Preoperative core biopsy was performed in 12%. All patients underwent lumpectomy, most commonly due to mass size (45%) or growth (29%). The median maximum dimension of a mass on preoperative ultrasound was 2.8 cm (IQR: 1.9). Most operations were performed by pediatric surgeons (65%) and breast surgeons (25%). The most frequent pathology was fibroadenoma (75%); 3% were phyllodes. BI-RADS scoring ≥4 on breast ultrasound had a sensitivity of 0% and a negative predictive value of 93% for identifying phyllodes tumors.
Most pediatric breast masses are self-identified and benign. BI-RADS classification based on ultrasound was not consistently assigned and had little clinical utility for identifying phyllodes.
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- Prevalence and longitudinal study of breast masses in adolescents.J Adolesc Health. 1993; 14: 277-281
- Analysis of surgically excised breast masses in 119 pediatric patients.Pediatr Surg Int. 2016; 32: 93-96
- Benign breast disorders.N Engl J Med. 2005; 353: 275-285
- Surgical breast lesions in adolescent females.Pediatr Surg Int. 2008; 25: 73
- Pediatric breast masses: an argument for observation.J Surg Res. 2018; 228: 247-252
- Pediatric breast fibroadenomas: a systematic review and algorithm for treatment.Ann Plast Surg. 2019; 83: 601-605
- Clinical breast concerns in low-risk pediatric patients: practice review with proposed recommendations.Pediatr Radiol. 2018; 48: 186-195
- Pathologic discordance to clinical management decisions suggests overtreatment in pediatric benign breast disease.Breast Cancer Res Treat. 2019; 176: 101-108
- How to approach breast lesions in children and adolescents.Eur J Radiol. 2015; 84: 1350-1364
- Diagnosis and treatment of symptomatic breast masses in the pediatric population.J Pediatr Surg. 1995; 30: 182-187
- Benign breast disease and the risk of breast cancer.N Engl J Med. 2005; 353: 229-237
- Pediatric and adolescent breast masses: a review of pathophysiology, imaging, diagnosis, and treatment.Am J Roentgenol. 2013; 200: W204-W212
- Differential diagnosis between fibroadenoma, giant fibroadenoma and phyllodes tumour: sonographic features and core needle biopsy.La radiologia Med. 2011; 116: 905-918
- Difficulties in the pre-operative diagnosis of phyllodes tumours of the breast: a study of 84 cases.Breast. 2007; 16: 27-37
- Solid breast masses diagnosed as fibroadenoma at fine-needle aspiration biopsy: acceptable rates of growth at long-term follow-up.Radiology. 2003; 229: 233-238
- Non-operative management of breast masses diagnosed as fibroadenoma.Br J Surg. 1995; 82: 792-794
- Breast Imaging-Reporting and Data System (BI-RADS) classification in 51 excised palpable pediatric breast masses.J Pediatr Surg. 2015; 50: 1746-1750
- Breast cancer screening and diagnosis, version 3.2018, NCCN clinical practice guidelines in oncology.J Natl Compr Cancer Netw. 2018; 16: 1362-1389
- Factors associated with phyllodes tumor of the breast after core needle biopsy identifies fibroepithelial neoplasm.J Surg Res. 2012; 178: 299-303
- Fibroepithelial breast lesions diagnosed by core needle biopsy demonstrate a moderate rate of upstaging to phyllodes tumors.Am J Surg. 2017; 214: 318-322
- Challenging breast lesions: pitfalls and limitations of fine-needle aspiration and the role of core biopsy in specific lesions.Diagn Cytopathol. 2012; 40: 262-272
- Determining whether excision of all fibroepithelial lesions of the breast is needed to exclude phyllodes tumor.JAMA Surg. 2014; 149: 1081
- Diagnostic performance of core needle biopsy in identifying breast phyllodes tumors.J Thorac Dis. 2016; 8: 3139-3151
- Characterizing excised breast masses in children and adolescents—can a more aggressive pathology be predicted?.J Pediatr Surg. 2020;
Published online: April 09, 2021
Accepted: January 18, 2021
Received in revised form: December 18, 2020
Received: October 5, 2020
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