Evolution of a local adolescent breast imaging service

The pathway for paediatric patients (<18 years) with breast-related symptoms from primary care has evolved in recent years within our region. Historically patients were managed at their local site within the region with varied management approaches, including young patients undergoing potentially unnecessary breast biopsies, and timelines adopted. In 2020, the establishment of a dedicated paediatric breast clinic enabled a smoother referral process from primary care, an appropriate clinical setting for the patient population and a standardised management pathway.

A retrospective review was performed of patients aged between 9 and 18 years referred to the breast service between 2017 and 2022. We reviewed the trends in referral numbers over the years, referral indications, ultrasound findings and clinical outcomes.

There has been a yearly increment in the number of patients referred, primarily driven by the 15-18 age group. The primary referral indication was a breast lump (52%), gynaecomastia (14%), abscess (9%), and breast pain (6%). The most prevalent ultrasound findings were a normal breast (41%) and a fibroadenoma (25%). Of patients presenting with a breast lump, 40% demonstrated a normal ultrasound and 46% fibroadenomas. Conservative management was opted for the majority of patients with simple fibroadenomas and gynaecomastia. An unusual case of dermatofibrosarcoma protruberans was identified, stressing the importance of prompt surgical review for rapidly growing masses.

The new clinic structure has optimized under-18 patient care, reducing unnecessary interventions and alleviating pressure on adult breast units. We propose a management pathway that can be adopted at a local/regional level.