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Cytological Assessment of Paediatric Breast Lesions: A Systematic Review
Ana Elisa Teles1, Fernando C Schmitt2,3
1Hospital Garcia de Orta, Almada, Portugal.
Insights
Fine-needle aspiration biopsy (FNAB) is effective for benign paediatric breast lesions but struggles with malignant cases. Real-time on-site evaluation (ROSE) improves diagnostic accuracy, guiding minimally invasive care for children.
Area of Science:
- Pediatric Oncology
- Diagnostic Pathology
- Surgical Pathology
Background:
- Paediatric breast lesions are uncommon, predominantly benign, yet cause significant parental concern.
- Fine-needle aspiration biopsy (FNAB) is a minimally invasive technique with debated utility in children due to interpretation challenges.
Purpose of the Study:
- To systematically review the utility, limitations, and diagnostic performance of FNAB in evaluating paediatric breast lesions.
- To assess the impact of adjunct techniques like Rapid On-Site Evaluation (ROSE) on FNAB accuracy in this population.
Main Methods:
- A systematic literature search was conducted in PubMed (January 2014 - February 2025).
- 38 studies were included for qualitative analysis after screening titles, abstracts, and reference lists.
- Data extraction and synthesis were performed manually.
Main Results:
- Benign lesions, primarily fibroadenomas, constituted the majority of cases.
- Malignant lesions were rare; FNAB showed high accuracy for benign conditions but limitations in differentiating malignant ones.
- ROSE improved sample adequacy, reduced inconclusive results, and enhanced diagnostic reliability.
Conclusions:
- FNAB is a valuable first-line tool for paediatric breast lesions, especially benign types.
- Correlation with clinical, radiological findings, and potential core biopsy is crucial for borderline/malignant cases.
- Integrating ROSE enhances FNAB's diagnostic yield, supporting multidisciplinary, minimally invasive management.
Introduction:
Paediatric breast lesions are rare and mostly benign. Despite their benign nature, the presence of these lesions in this population often raises concerns. Fine-needle aspiration biopsy (FNAB) offers a minimally invasive, though its application in paediatric populations remains debated due to interpretative challenges. This systematic review aims to assess the utility, limitations, and diagnostic performance of FNAB in the evaluation of paediatric breast lesions.
Methods:
A systematic search was performed in PubMed for articles published from January 2014 to February 2025. Non-humans and non-English language reports were excluded. Based on title and abstract screening, 25 articles were selected, and 13 additional articles were retrieved through reference list, yielding a total of 38 studies for qualitative analysis. Data were manually extracted and synthesized.
Results:
Benign lesions represented the majority of cases, with fibroadenomas being the most frequent (65%-95%), followed by benign phyllodes tumours, hamartomas, tubular adenomas, pseudoangiomatous stromal hyperplasia (PASH), and cystic lesions. Malignant lesions were rare and included metastatic tumours, malignant phyllodes tumours, secretory carcinoma, and primary breast sarcomas. FNAB demonstrated high diagnostic accuracy for benign lesions but showed limitations in distinguishing benign from malignant tumours. ROSE was identified as a valuable adjunct, improving sample adequacy, reducing the rate of inconclusive results, and enhancing diagnostic reliability.
Conclusion:
FNAB is an effective first-line diagnostic modality for paediatric breast lesions, offering high accuracy for benign conditions. However, limitations exist in discriminating borderline and malignant lesions, warranting correlation with clinical, radiological findings, and, in some cases, core biopsy confirmation. The integration of ROSE enhances FNAB diagnostic yield and may further refine management strategies. A multidisciplinary approach remains essential to ensure optimal, minimally invasive care for paediatric patients.
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