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Özdamar MY, Biçer Ş. Importance of parental anxiety in management of developmental breast conditions in children: A study with a prospective hierarchical regression model. Medicine (Baltimore) 2024; 103:e38514. [PMID: 38875389 PMCID: PMC11175848 DOI: 10.1097/md.0000000000038514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2024] Open
Abstract
The parent is the most critical link and decision-maker between the patient and the healthcare provider in treating many pediatric diseases. This entity is essential for the management of pediatric breast diseases for which the rate of surgical intervention is known to be very low. Although previous publications have emphasized that pediatric breast diseases may cause alarming anxiety in parents, the demographic factors that influence this anxiety have not been investigated. Even if practitioners complete patient management with appropriate procedures, treatment is incomplete if the questions remain unanswered. In this observational prospective study, we investigated the demographic factors that affect parental anxiety, which should be prioritized to prevent incomplete management. The Beck Anxiety Inventory score (BAS) created by the parents of 409 boys and girls aged 0 to 17 with breast conditions was recorded at the diagnosis, termination of treatment, and final control stages. A 2-stage hierarchical logistic regression model was applied to show how strongly the demographic characteristics of parents and their children predicted the parental BAS. Of the demographic characteristics, there was a significant correlation (P < .05) between the patient's sex, age, developmental period, Tanner stage, referral status, management method, family's place of residence, economic distress, and BAS. However, according to the 2-stage hierarchical regression model, only 3 demographic characteristics, the patient's gender, place of residence, and method used in patient management, significantly predicted BAS (P < .05, ΔR2 = .35). Among the many factors that affect anxiety experienced by parents whose son or daughter has breast problems, the gender of the child, place of residence of the family, and management methods used by the practitioner are demographic characteristics that should be taken into consideration.
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Affiliation(s)
- Mustafa Yaşar Özdamar
- Department of Pediatric Surgery, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey
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Millan-Arreola E, Lozano-Jaramillo DA, Tello De Meneses-Salazar A, Esquer-Cota OO, Lavara-Miranda LA, Valenzuela-Espinoza MA. Borderline Phyllodes Tumor in a Child. World J Oncol 2023; 14:584-588. [PMID: 38022409 PMCID: PMC10681785 DOI: 10.14740/wjon1716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/12/2023] [Indexed: 12/01/2023] Open
Abstract
Phyllodes tumor (PT) is considered a rare fibroepithelial tumor. Very few series have been reported in children and adolescents. Based on histopathological features, it can be classified as benign, borderline, or malignant, with the latter having a more aggressive clinical behavior. We report the case of a 10-year-old female who began with an asymptomatic mobile right breast mass. An initial fine needle biopsy (FNB) concluded fibroadenoma (FA). Months later, the mass kept growing, with the appearance of pain and nipple discharge. Benign PT was demonstrated in a new biopsy. A total mastectomy was performed. The post-surgical histopathological examination was compatible with a borderline PT. The patient is now symptom-free and with no signs of relapse. Not all breast masses in the pediatric or adolescent age bracket are FA. Attention is warranted when the clinical behavior does not follow the usual outline. PT has to be considered as a possible diagnosis and treated accordingly.
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Affiliation(s)
| | - Diego Alberto Lozano-Jaramillo
- Centro Oncologico Pediatrico de Baja California, Tijuana, Mexico
- Centro de Investigacion Valle Bibb Fundacion, Tijuana, Mexico
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Mubarak F, Malick A, Sattar AK. Breast development and disorders in children and adolescents. Curr Probl Pediatr Adolesc Health Care 2023; 53:101441. [PMID: 37914550 DOI: 10.1016/j.cppeds.2023.101441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Breast masses are infrequently encountered in pediatric and adolescent populations. Most breast masses in children are benign entities arising from embryological defects which can be managed once breast development is complete. Diagnostic and management dilemmas arise when fibroepithelial lesions of the breast are seen in clinical practice. Differentiation between a fibroadenoma and a phyllodes tumor is important to guide management. Breast cancer in children under 18 years of age is extremely rare and invasive diagnostic testing and aggressive management is only recommended when clinical suspicion of malignancy is very high. Patient and caregiver counseling plays an important role in the management of these diseases. While adult-onset breast diseases have been studied very closely, there is a dearth of literature on pediatric breast anomalies. This review aims to provide a scoping overview of the available literature on benign, fibroepithelial, and malignant lesions of the breast in pediatric and adolescent populations to help guide physicians and surgeons with decision-making regarding the diagnosis and management of pediatric breast diseases.
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Affiliation(s)
- Fatima Mubarak
- Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Ayesha Malick
- Medical College, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Abida K Sattar
- Aga Khan University, Department of Surgery, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan.
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Ostertag-Hill CA, Wang Y, Nickolich S, Wiggins DL. Bloody nipple discharge due to intraductal papilloma in an adolescent girl. BMJ Case Rep 2023; 16:e254177. [PMID: 36878614 PMCID: PMC9990612 DOI: 10.1136/bcr-2022-254177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
An early adolescent girl was referred to our breast surgery clinic with multiple right-sided breast masses and several months of unilateral bloody nipple discharge. MRI demonstrated multiple enhancing masses in the right breast with intrinsic hypertensive T1 signal of the ducts extending to the nipple. A biopsy showed partially sclerosed intraductal papillomas without atypia or malignancy. Following extensive counselling with the patient and her family, two palpable breast masses and a single central breast duct responsible for bloody nipple discharge were fully excised. Histopathological analysis showed unique overlapping features of resembling intraductal papilloma, nipple adenoma and fibroadenomas. The patient has had resolution of her bloody nipple discharge and excellent cosmetic outcomes post-surgery. Intraductal papilloma is rare in the adolescent population and the risk of concurrent and future malignancy is not well established. Thus, a tailored approach to the work-up and management of paediatric breast masses is essential.
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Affiliation(s)
- Claire Alexandra Ostertag-Hill
- Department of Surgery, Rhode Island Hospital, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Yihong Wang
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Stana Nickolich
- Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Doreen L Wiggins
- Department of Surgery, Rhode Island Hospital, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
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Davis J, Liang J, Roh A, Kittrell L, Petterson M, Winton L, Connell M, Viscusi R, Komenaka I, Jamshidi R. Use of breast imaging-reporting and data system (BI-RADS) ultrasound classification in pediatric and adolescent patients overestimates likelihood of malignancy. J Pediatr Surg 2021; 56:1000-1003. [PMID: 33494944 DOI: 10.1016/j.jpedsurg.2020.12.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 12/21/2020] [Accepted: 12/28/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND/PURPOSE Breast masses in the pediatric population cause patient and family concern, partially driven by public awareness of adult breast cancer. However, the spectrum of breast masses in children differs greatly from that in adults, and malignancy is exceedingly rare. The American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) ultrasound-based classification system is the diagnostic standard, yet no study has validated BI-RADS in pediatric patients. This study compares BI-RADS classification with histologic diagnoses to evaluate BI-RADS validity in pediatric patients. METHODS Multicenter retrospective evaluation of breast masses in patients under 21 years. Ultrasound reports were compared with histologic diagnoses. RESULTS There were 283 patients with breast pathology results after excluding clinical diagnoses of gynecomastia. Mean age was 16.9 (SD 2.3), ranging 10-20 years. 227 had pre-operative ultrasounds, and 84% (191/227) were assigned a BI-RADS category. BI-RADS 4 was the most frequent category (55%, n = 124), by definition predicting 2 - 95% likelihood of malignancy. However, pathology was benign in all patients. CONCLUSIONS The current BI-RADS categorization system overestimates cancer risk when applied to pediatric patients. BI-RADS scores should not be assigned to pediatric patients, and BIRADS-defined recommendations for biopsy should be disregarded. A pediatric-specific classification system could be useful.
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Affiliation(s)
- John Davis
- Valleywise Health Medical Center, Phoenix, AZ, United States
| | - Juliana Liang
- The University of Arizona College of Medicine, Phoenix, Phoenix, AZ, United States
| | - Albert Roh
- Valleywise Health Medical Center, Phoenix, AZ, United States
| | - Laurel Kittrell
- The University of Arizona College of Medicine, Tucson, Tucson, AZ, United States
| | - Matthew Petterson
- The University of Arizona College of Medicine, Phoenix, Phoenix, AZ, United States
| | - Lisa Winton
- Valleywise Health Medical Center, Phoenix, AZ, United States
| | - Mary Connell
- Valleywise Health Medical Center, Phoenix, AZ, United States
| | - Rebecca Viscusi
- The University of Arizona College of Medicine, Tucson, Tucson, AZ, United States
| | - Ian Komenaka
- Valleywise Health Medical Center, Phoenix, AZ, United States
| | - Ramin Jamshidi
- Valleywise Health Medical Center, Phoenix, AZ, United States; The University of Arizona College of Medicine, Phoenix, Phoenix, AZ, United States; Phoenix Children's Hospital, Phoenix, AZ, United States.
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Management of Pediatric Breast Masses: A Multi-institutional Retrospective Cohort Study. J Surg Res 2021; 264:309-315. [PMID: 33845414 DOI: 10.1016/j.jss.2021.01.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/18/2020] [Accepted: 01/18/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The objective of our study was to describe the workup, management, and outcomes of pediatric patients with breast masses undergoing operative intervention. MATERIALS AND METHODS A retrospective cohort study was conducted of girls 10-21 y of age who underwent surgery for a breast mass across 11 children's hospitals from 2011 to 2016. Demographic and clinical characteristics were summarized. RESULTS Four hundred and fifty-three female patients with a median age of 16 y (IQR: 3) underwent surgery for a breast mass during the study period. The most common preoperative imaging was breast ultrasound (95%); 28% reported the Breast Imaging Reporting and Data System (BI-RADS) classification. Preoperative core biopsy was performed in 12%. All patients underwent lumpectomy, most commonly due to mass size (45%) or growth (29%). The median maximum dimension of a mass on preoperative ultrasound was 2.8 cm (IQR: 1.9). Most operations were performed by pediatric surgeons (65%) and breast surgeons (25%). The most frequent pathology was fibroadenoma (75%); 3% were phyllodes. BI-RADS scoring ≥4 on breast ultrasound had a sensitivity of 0% and a negative predictive value of 93% for identifying phyllodes tumors. CONCLUSIONS Most pediatric breast masses are self-identified and benign. BI-RADS classification based on ultrasound was not consistently assigned and had little clinical utility for identifying phyllodes.
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Koksal H, Ates D, Kara B. Breast complaints in children and the effect of family history. Pediatr Int 2021; 63:279-283. [PMID: 32745292 DOI: 10.1111/ped.14418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/23/2020] [Accepted: 07/28/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND To evaluate the correlation of physical examination, and radiological and pathological findings of children and adolescents with breast-related complaints. METHODS Children and adolescents with breast complaints between January 2016 and December 2019 were analyzed retrospectively. RESULTS A total of 118 children and adolescent patients were included. Their ages ranged from 12 to 18 years (median, 16 years). Twenty-one patients had a family history of breast cancer (17.8%). The most common complaints were pain, mass, and nipple discharge. Physical examination revealed mass (41.5%), tenderness (11%), and fullness (8.5%). Thirty-nine patients were classified ultrasonographically with Breast Imaging Reporting and Data System (BIRADS) 3 (39.4%) and four patients were BIRADS 4 (4%). Excision was applied to all patients with BIRADS 4, and 13 of 39 patients with BIRADS 3. Pathological diagnoses of the patients with BIRADS 3 were fibroadenoma (n: 12, 92.3%) and benign phyllodes tumor (n: 1, 7.7%). In patients with BIRADS 4, three patients had fiboradenomas and one patient had a benign phyllodes tumor. No recurrence was observed in any patients who had an excision. Only six of the patients with positive family history had BIRADS 3 lesions, and the others were BIRADS 1. Excision was recommended in two patients and the pathological diagnoses were fibroadenoma. CONCLUSION In this age group, the most common complaints were pain and mass, while physical examination was normal in nearly half of the patients. All of the pathological diagnoses were benign. While evaluating the patients in this age range, the experience of the clinician and radiologist is important and we think that it is necessary to increase the awareness of the patient and family about physiological breast development and self-breast examination.
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Affiliation(s)
- Hande Koksal
- Department of General Surgery, Hamidiye Faculty of Medicine, Konya Education and Research Hospital, Saglik Bilimleri University, Konya, Turkey
| | - Dervis Ates
- Department of General Surgery, Hamidiye Faculty of Medicine, Konya Education and Research Hospital, Saglik Bilimleri University, Konya, Turkey
| | - Buket Kara
- Department of Pediatric Hematology and Oncology, Faculty of Medicine, Selcuk University, Konya, Turkey
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Granger CJ, Hogan AR, Neville HL, Thorson CM, Perez EA, Sola JE, Brady AC. The limited role of ultrasound in the surgical assessment of solid pediatric breast lesions. Clin Imaging 2021; 74:100-105. [PMID: 33465666 DOI: 10.1016/j.clinimag.2020.12.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/28/2020] [Accepted: 12/31/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Ultrasound (US) is an adjunct to history and clinical exam (CE) in the assessment of pediatric breast lesions. We sought to investigate the reliability of US and CE to predict final pathologic diameter (P). METHODS A single institutional retrospective analysis of patients aged ≤18 years who underwent breast mass resection was performed. Data was collected and analyzed using SPSS. RESULTS 88 patients met inclusion criteria with an average age at surgery of 16 ± 1.5 years. No malignancies were encountered. The largest mean diameter measured by final pathology (MPØ) for all lesions was 4.1 ± 2.6 cm. Pathology encountered were fibroadenoma (83%, MPØ 3.7 ± 1.7 cm), juvenile fibroadenoma (10%, MPØ 7.0 ± 5.4 cm), and low-grade phyllodes tumor (3%, MPØ 6.2 ± 3.8 cm). 67 patients had documented CE measurement with a mean diameter of 3.4 ± 1.8 cm. 62 patients underwent US with a mean diameter of 3.3 ± 1.6 cm. US and CE were accurate in determining P by Cronbach Alpha reliability testing. CONCLUSION US and CE are reliable measurements of P. The surgical utility of US when considering pediatric breast lesions is limited and should be individualized following pediatric surgical evaluation and CE.
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Affiliation(s)
- Caroline J Granger
- Leonard M. Miller School of Medicine, University of Miami, 1600 NW 10th Ave, Suite 1140, Miami, FL 33136, USA
| | - Anthony R Hogan
- Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 450, Miami, FL 33136, USA
| | - Holly L Neville
- Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 450, Miami, FL 33136, USA
| | - Chad M Thorson
- Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 450, Miami, FL 33136, USA
| | - Eduardo A Perez
- Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 450, Miami, FL 33136, USA
| | - Juan E Sola
- Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 450, Miami, FL 33136, USA
| | - Ann-Christina Brady
- Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 450, Miami, FL 33136, USA.
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Wright AG, Hayward JH, Price ER, Ray KM, Joe BN, Lee AY. Primum non nocere: Utility and outcomes of pediatric breast ultrasound. Clin Imaging 2020; 68:131-135. [PMID: 32599442 DOI: 10.1016/j.clinimag.2020.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 06/07/2020] [Accepted: 06/16/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To assess the use and outcomes of ultrasound for the evaluation of breast signs and symptoms in pediatric females. METHODS A retrospective database review identified all patients ≤18-years-old who underwent breast ultrasound at an academic institution over a 20-year period. Each symptomatic site was designated a case and analyses were performed on each case. Imaging findings were obtained from the radiology reports. Clinical and pathology data were obtained from the medical records. Descriptive statistics were performed. RESULTS The final cohort comprised 124 cases in 101 patients. Mean age was 15 years (range 1-18). The most common indication for ultrasound was a palpable lump (71%). Thirty-seven cases (30%) demonstrated no sonographic correlate to the symptom; 36 (29%) had a benign correlate. The most common benign correlates were abscess/phlegmon and cyst. All cases of abscess/phlegmon had infectious symptoms. Fifty-one cases (41%) demonstrated a sonographic mass that was not characteristically benign. Of these indeterminate masses, 27 were recommended for biopsy, 13 for short-interval follow-up, and 6 had no recommendation. Of 27 biopsied masses, 63% were fibroadenomas. No symptoms were due to malignancy. Therefore, the NPV of ultrasound was 100% and the PPV 0%. CONCLUSION In this cohort of pediatric and adolescent patients, malignancy was never the cause of breast symptoms. Imaging yielded false positives with a biopsy recommendation in 22% of cases. Ultrasound provided value in evaluating infectious symptoms. Given the extreme rarity of breast cancer in this population, surveillance may be a safe alternative for most indeterminate lesions.
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Affiliation(s)
- Alexandra G Wright
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Jessica H Hayward
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Elissa R Price
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Kimberly M Ray
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Bonnie N Joe
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Amie Y Lee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
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Cohen O, Avinadav E, Sharon E, Pirogovsky A, Freud E. Pediatric and Adolescent Surgical Breast Clinic: Preliminary Experience. J Pediatr Adolesc Gynecol 2020; 33:23-26. [PMID: 31445140 DOI: 10.1016/j.jpag.2019.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/03/2019] [Accepted: 08/15/2019] [Indexed: 02/05/2023]
Abstract
STUDY OBJECTIVE The diagnostic and treatment tools used in breast centers are largely geared to adults, and there is little consideration of the unique characteristics of breast diseases in younger age groups. Herein we report on the preliminary experience of a specialized breast clinic for children and adolescents. DESIGN Retrospective, observational. SETTING Pediatric Surgical Breast Clinic of Schneider Children's Medical Center of Israel. PARTICIPANTS Patients referred to the clinic during the first 18 months of its establishment. INTERVENTIONS AND MAIN OUTCOME MEASURES Rate of breast masses, rate of malignancy, and types of evaluation and treatment. RESULTS Forty-seven patients aged 0-19 years were referred. Breast masses were suspected in 23/47 (48.9%) and confirmed using ultrasound in 14/47 (29.7%; mean age, 16.4 years), followed by needle core biopsy in 7. Seven patients had multiple masses. Breast Imaging and Reporting Data System scores ranged from 3 to 4b. All cases were treated as fibroadenomas. Four patients underwent surgery because of a large mass (>5 cm; n = 3) or patient's preference to remove the lump rather than follow-up (n = 1). There were no malignancies. The median time from patient identification of the mass until seeking medical help was 5 months. CONCLUSION Several findings distinct to this age group were highlighted: high rate of multiple masses, lack of malignancy, and high risk of delayed diagnosis. Care should be taken when using Breast Imaging and Reporting Data System categorization because it was formulated for adults and might be very limited in the adolescent population. Longer-term studies of larger cohorts are planned.
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Affiliation(s)
- Osher Cohen
- Departments of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Efrat Avinadav
- Departments of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Sharon
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Avinoam Pirogovsky
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Medical Management, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Enrique Freud
- Departments of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Pathologic discordance to clinical management decisions suggests overtreatment in pediatric benign breast disease. Breast Cancer Res Treat 2019; 176:101-108. [PMID: 30982196 DOI: 10.1007/s10549-019-05224-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 04/03/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Breast masses in pediatric patients are often managed similarly to adult breast masses despite significant differences in pathology and natural history. Emerging evidence suggests that clinical observation is safe. The purpose of this study was to quantify the clinical appropriateness of the management of benign breast disease in pediatric patients. METHODS A multi-institutional retrospective cohort study was completed between 1995 and 2017. Patients were included if they had benign breast disease and were 19 years old or younger. A timeline of all interventions (ultrasound, biopsy, or excision) was generated to quantify the number of patients who were observed for at least 90 days, deemed appropriate care. To quantify inappropriate care, the number of interventions performed within 90 days, and the pathologic concordance to clinical decisions was determined by reviewing the radiology reports of all ultrasounds and pathology reports of all biopsies and excisions. RESULTS A total of 1,909 patients were analyzed. Mean age was 16.4 years old (± 2.1). The majority of masses were fibroadenomas (60.4%). Only half of patients (54.3%) were observed for 90 or more days. 81.1% of interventions were unnecessary, with pathology revealing masses that would be safe to observe. The positive predictive value (PPV) of clinical decisions made based on suspicious ultrasound findings was 16.2%, not different than a PPV of 21.9% (p < 0.25) for decisions made on clinical suspicion alone. CONCLUSION Despite literature supporting an observation period for pediatric breast masses, half of patients had an intervention within three months with one out of ten patients undergoing an invasive procedure within this time frame. Furthermore, 81.1% of invasive interventions were unnecessary based on final pathologic findings. A formal consensus clinical guideline for the management of pediatric benign breast disease including a standardized clinical observation period is needed to decrease unnecessary procedures in pediatric patients with breast masses.
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