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Beyond size: the role of growth rate in managing adolescent breast masses
Natalia M Barron-Cervantes1, David C Chang2, Cassandra M Kelleher1
1Department of Pediatric Surgery, Massachusetts General Hospital, Boston, MA, USA.
Introduction:
Adolescent breast masses are predominantly benign. Yet, distinguishing lesions that require intervention is critical. Current American Pediatric Surgical Association guidelines provide limited guidance for the management of masses <5 cm. The goal of this study was to develop a data-driven clinical management guideline for small adolescent breast masses.
Methods:
Growth dynamics were assessed in a retrospective cohort of female patients ≤21 years with breast masses using serial measurements, and risk-optimized growth threshold was derived using Youden's J statistic.
Results:
344 patients (median 19.6 years [IQR, 17.8-20.9]) with 435 breast masses were included. Most masses (430 [98.8%]) were <5 cm. Overall, 56 masses (12.8%) required intervention, including 3 malignancies (0.6%) and 53 hypercellular lesions (12.2%). A growth rate threshold >22.5%/3 months distinguished hypercellular from non-hypercellular lesions.
Conclusions:
Among adolescent breast masses <5 cm, a growth rate threshold of 22.5%/3 months can be used for risk stratification and to guide selective intervention.
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