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Management of Pediatric Breast Masses for the Pediatric Surgeon: Expert Consensus Recommendations From the APSA
Dana Schwartz1, Elisabeth T Tracy2, Bindi Naik-Mathuria3
1Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, 700 Children's Drive, Columbus, OH 43205, USA.
Insights
Pediatric breast masses are usually benign, but rare malignancies require prompt care. This guide offers an algorithm for pediatric surgeons to diagnose and manage these lesions, prioritizing breast preservation.
Area of Science:
- Pediatric Surgery
- Breast Pathology
- Oncology
Background:
- Pediatric breast masses differ significantly from adult cases, with most being benign.
- Malignant breast masses in children are rare but necessitate urgent diagnosis and treatment.
- Management requires balancing breast preservation with accurate diagnosis and surgical intervention.
Purpose of the Study:
- To establish an evidence-based algorithm for the clinical evaluation and management of breast masses in pediatric and adolescent patients.
- To provide guidance for pediatric surgeons in differentiating benign from malignant breast lesions.
- To emphasize breast tissue and nipple-areolar complex preservation during surgical procedures.
Main Methods:
- Comprehensive review of the English language literature on pediatric and adolescent breast masses.
- Classification of identified manuscripts by level of evidence.
- Development of a clinical workup and management algorithm based on literature review and expert consensus.
Main Results:
- Initial evaluation involves thorough history and physical examination.
- Ultrasound-guided assessment is recommended for palpable masses.
- Observation is suitable for select cases; surgical management prioritizes tissue conservation. Excisional biopsy is preferred over core needle biopsy when feasible.
Conclusions:
- Pediatric surgeons play a pivotal role in managing pediatric breast masses.
- A proposed algorithm aids in the diagnosis and treatment of predominantly benign pediatric breast lesions.
- A multidisciplinary approach is recommended for managing rare malignant breast masses in pediatric patients.
Background:
The pathology and management of breast masses in pediatric patients is markedly different than in adults. The vast majority of lesions in children and adolescents are benign, but the rare malignant breast masses require prompt recognition and treatment. Pediatric surgeons navigating clinical evaluation of these masses must balance preservation of the developing breast with appropriate diagnosis and surgical management.
Methods:
The current English language literature was queried for pediatric and adolescent breast masses. Identified manuscripts were reviewed and classified by level of evidence. Based on these results, as well as expert consensus, an algorithm regarding clinical workup and management was established.
Results:
Evaluation of pediatric breast masses begins with a thorough history and physical exam. Palpable masses should then be further characterized using an ultrasound-guided algorithm. In select cases, observation without surgical resection is appropriate. Surgical management of presumed benign lesions, when performed, should prioritize conserving developing breast tissue and the nipple areolar complex. Excisional biopsy is preferable to core needle biopsy when technically feasible. Surgical management of malignant lesions varies depending on the type of malignancy.
Conclusion:
Pediatric surgeons are often the first point of contact after identification of a breast mass in a pediatric or adolescent patient, and therefore play a critical role in management. Based on literature review and expert consensus, we propose an algorithm to guide pediatric surgeons in the diagnosis and treatment of these predominantly benign lesions. For the rare malignant lesions, a multi-disciplinary team approach is recommended to optimize patient care.
