Pediatric and adolescent breast masses: imaging evaluation and management-An educational review

Breast complaints in children and adolescents are common, anxiety-provoking, and overwhelmingly benign. This educational review distills a practical approach for general, pediatric, and breast radiologists that emphasizes ultrasound-first imaging only when clinically indicated, focused history and examination, and judicious follow-up. We summarize normal pubertal development and common benign entities, outline red flags that warrant expedited assessment, and present stepwise algorithms for evaluation and management that balance diagnostic confidence with protection of the developing breast. Benign-appearing solid masses under 5 cm without worrisome sonographic features are typically observed with interval ultrasound, recognizing that spontaneous regression is common adolescents. Escalation is reserved for rapid growth, lesions ≥5 cm, classic suspicious features, or discordance between imaging and clinical findings; tissue sampling should be targeted, with careful attention to radiology-pathology concordance and sampling adequacy. We highlight pitfalls that mimic disease (e.g., normal pubertal tissue, gynecomastia) and provide structured reporting templates and checklists to standardize communication, reduce unnecessary intervention, and support counseling of patients and families. By consolidating current evidence and everyday experience into actionable guidance, this review aims to improve consistency, minimize harm, and streamline care for young patients presenting with breast symptoms.