Management of Pediatric Breast Masses: A Multi-institutional Retrospective Cohort Study

Area of Science:

• Pediatric Surgery
• Surgical Oncology
• Breast Health

Background:

• Pediatric breast masses are common, often presenting as self-identified lumps.
• Operative intervention is sometimes necessary for diagnosis and management.
• Understanding workup, management, and outcomes is crucial for this population.

Purpose of the Study:

• To describe the workup, management, and outcomes of pediatric patients with breast masses.
• To evaluate the utility of preoperative imaging and biopsy in diagnosis.
• To analyze the pathological findings and surgical approaches.

Main Methods:

• Retrospective cohort study of girls aged 10-21 years undergoing surgery for breast masses.
• Data collected from 11 children's hospitals between 2011 and 2016.
• Analysis of demographic, clinical, imaging, pathological, and surgical data.

Main Results:

• 453 female patients underwent surgery, with fibroadenoma being the most common pathology (75%).
• Breast ultrasound was the primary imaging modality (95%); Breast Imaging Reporting and Data System (BI-RADS) classification was inconsistently applied (28%).
• BI-RADS scoring ≥4 had 0% sensitivity and 93% negative predictive value for phyllodes tumors, indicating limited utility.

Conclusions:

• The majority of pediatric breast masses are benign and self-detected.
• Preoperative Breast Imaging Reporting and Data System (BI-RADS) classification on ultrasound has minimal clinical value for identifying rare malignant or aggressive phyllodes tumors.
• Standard lumpectomy is the common surgical approach, often driven by mass size or growth.