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Diagnosis and treatment of symptomatic breast masses in the pediatric population
K W West1, F J Rescorla, L R Scherer
1Department of Surgery, Indiana University School of Medicine, Indianapolis, USA.
Insights
Pediatric breast masses are rarely malignant. Most cases of breast masses in children and adolescents can be managed nonoperatively or with minimal intervention, conserving healthcare resources.
Area of Science:
- Pediatric Surgery
- Pediatric Endocrinology
- Surgical Oncology
Background:
- Breast masses in children and adolescents are uncommon.
- Evaluation of these masses requires careful consideration to differentiate benign from malignant conditions.
Purpose of the Study:
- To analyze the causes and management of palpable breast masses in pediatric patients.
- To determine the incidence of malignancy and the effectiveness of nonoperative management.
Main Methods:
- Retrospective review of 74 pediatric patients (1980-1993) with palpable breast masses.
- Categorization of masses based on diagnosis and management (operative vs. nonoperative).
Main Results:
- 32 patients were managed nonoperatively for conditions including unilateral thelarche, fibroadenoma, gynecomastia, and hemorrhagic cysts.
- 42 patients underwent surgery for giant or painful fibroadenomas, breast abscesses, painful gynecomastia, or metastatic disease.
- No cases of primary breast malignancy were identified.
Conclusions:
- Palpable breast masses in pediatric patients are predominantly benign.
- Conservative management and selective diagnostic testing are effective and cost-efficient.
- Emphasis on clinical evaluation can reduce unnecessary surgical interventions for pediatric breast masses.
Abstract:
Between 1980 and 1993, 74 children and adolescents were referred for surgical evaluation of palpable breast masses. Thirty-two were managed nonoperatively for unilateral thelarche (26), fibroadenoma (3), gynecomastia (2), or hemorrhagic cyst (1). The other 42 children had surgical intervention for giant or painful fibroadenomas (19), breast abscesses (5), painful gynecomastia (6), metastatic disease (4), or other conditions (8). No instances of primary breast malignancy were noted. Physical examination and minimal (selective) diagnostic testing can conserve health care dollars in cases of pediatric patients with breast masses.