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Analysis of surgically excised breast masses in 119 pediatric patients
Jamie Knell1, Jeffery L Koning2, Julia E Grabowski3
1Department of General Surgery, Brigham and Women's Hospital, Boston, MA, USA. jknell1@partners.org.
Insights
Pediatric breast masses are overwhelmingly benign, with fibroadenoma being most common. Patient anxiety, not malignancy, often drives surgical decisions, suggesting a need for revised management strategies for pediatric breast masses.
Area of Science:
- Pediatric Surgery
- Pediatric Oncology
- Breast Imaging
Background:
- Breast masses in pediatric and adolescent populations are rare.
- Most pediatric breast masses are benign.
- Clinical management approaches for pediatric breast masses vary significantly.
Purpose of the Study:
- To analyze the demographics, pathology, and management of 119 pediatric patients with breast masses.
- To provide insights into the largest studies on pediatric breast masses to date.
- To inform clinical decision-making and management strategies for pediatric breast masses.
Main Methods:
- Retrospective review of pediatric patients undergoing breast mass excision.
- Data collected from June 2009 to November 2013 at a single pediatric center.
- Analysis included patient demographics, imaging findings, histopathology, and treatment management.
Main Results:
- The study included 119 pediatric patients with an average age of 15.3 years.
- All resected breast masses were benign, with fibroadenoma being the most frequent diagnosis (75.2%).
- Patient and family anxiety was the primary reason for surgery in 31.9% of cases, with no malignancies identified.
Conclusions:
- No malignancies were found in the studied cohort of pediatric breast masses.
- A significant proportion of surgeries (31.9%) were driven by patient/family anxiety, potentially indicating unnecessary procedures.
- Findings suggest that the low risk of malignancy in pediatric breast masses could lead to more conservative management strategies and reassurance for patients and families.
Purpose:
Breast masses in children and adolescents are uncommon and the vast majority are benign. There are currently limited analyses of breast masses in this population and clinical management is highly variable between institutions and providers. The purpose of our study is to analyze the demographics, pathology and management of 119 pediatric patients with breast masses; one of the largest studies to date.
Methods:
We performed a retrospective review of patients who underwent excision of a breast mass at a single pediatric center from June 2009 to November 2013. Demographics, imaging, pathology and management were reviewed.
Results:
Average patient age was 15.3 years, average mass size was 3.15 cm and 20.3 % had a family history of breast cancer. 68 % of patients had pre-operative ultrasound, and 31.9 % underwent a period of observation. The most common indication for resection was patient and family anxiety. All masses were benign, with fibroadenoma being the most common histopathology (75.2 %).
Conclusions:
In our cohort there were no cases of malignancy. Only 31.9 % of patients underwent some form of observation and patient or family anxiety was the most common indication for proceeding with surgery. This suggests that patient anxiety may result in unnecessary operation. Our data may help reassure patients, families and providers that the risk of malignancy is low and could help develop more optimal management strategies.
