Pediatric breast masses: an argument for observation
Cory M McLaughlin1, Jessica Gonzalez-Hernandez1, Monica Bennett2
1Department of Surgery, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas.
Insights
Pediatric breast masses are typically benign. This study found that asymptomatic breast lesions in children can be safely managed nonoperatively, with surgery decisions individualized rather than based on size alone.
Area of Science:
- Pediatric Surgery
- Oncology
- Radiology
Background:
- Pediatric breast masses present diagnostic challenges, with most being benign.
- There is no established consensus on the surgical management of pediatric breast masses.
- This study investigated the safety and efficacy of nonoperative management for asymptomatic pediatric breast lesions.
Purpose of the Study:
- To evaluate the outcomes of nonoperative management for asymptomatic pediatric breast masses.
- To determine if lesion size correlates with malignancy risk in pediatric breast masses.
- To provide evidence-based recommendations for the management of pediatric breast lesions.
Main Methods:
- Retrospective review of pediatric patients (≤18 years) who underwent breast mass excision from 2008 to 2016.
- Exclusion of male patients with gynecomastia and those who had needle biopsy without formal excision.
- Statistical analysis including Pearson correlation for size comparison and Kruskal-Wallis test for diagnosis comparison.
Main Results:
- 196 patients were included, predominantly female (96%), with a mean age of 15 years.
- Fibroadenoma was the most common benign diagnosis (81.5%); no malignant lesions were found.
- Ultrasound size accurately correlated with pathologic size (Pearson correlation 0.84, P < 0.0001), with no size-diagnosis association.
Conclusions:
- All pediatric breast masses surgically removed over 9 years were benign, most commonly fibroadenoma.
- Ultrasound is a reliable size predictor, but larger lesions do not indicate higher malignancy risk.
- Observation is suitable for asymptomatic pediatric breast masses; surgical decisions should be individualized, not solely based on size.
Background:
Pediatric breast masses can be a diagnostic challenge. Nearly all are benign, but there is no consensus on which should be removed. We hypothesized that children with asymptomatic breast lesions can be safely managed nonoperatively.
Methods:
We performed a single-institution retrospective review of children (≤18 y) who underwent breast mass excision from 2008 to 2016. Male patients with gynecomastia and those who had needle biopsy without formal excision were excluded. Pearson correlation was used to compare ultrasound and pathologic size. Kruskal-Wallis test was used to compare size and final diagnosis.
Results:
One hundred ninety-six patients were included (96% female). Mean age was 15 ± 3 y. Most patients (71%) presented with a painless mass. Preoperative ultrasound was obtained in 70%. Pathology included fibroadenoma (81.5%), tubular adenoma (5%), benign phyllodes tumor (3%), benign fibroepithelial neoplasm (0.5%), and other benign lesions (10%). There were no malignant lesions. Ultrasound size had a Pearson correlation of 0.84 with pathologic size (P < 0.0001). There was no association between the size and final diagnosis.
Conclusions:
Over 9 y, all pediatric breast masses removed at a single center were benign, most commonly fibroadenoma. Ultrasound was an accurate predictor of size, but large lesions did not necessarily confer a high malignancy risk. Observation is appropriate for asymptomatic breast masses in children. Decision for surgery should be individualized and not based on size alone.
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