Surgical Treatment of the Solid Breast Masses in Female Adolescents

doi:10.1016/j.jpag.2012.09.004

Journal of Pediatric and Adolescent Gynecology

Volume 26, Issue 1, February 2013, Pages 31-35

https://doi.org/10.1016/j.jpag.2012.09.004 Get rights and content

Abstract

Study Objective

To evaluate the histopathologic results of the excised solid breast masses in our clinic and to draw attention to breast masses in adolescents.

Design

A retrospective chart review study and review of the literature.

Setting

This study was conducted in Baskent University Adana Research Center between March 2003 and May 2011.

Participants

Patients included 10 adolescent girls admitted to pediatric surgery clinic with the complaint of palpable breast mass who underwent surgical excision of the breast mass.

Main Outcome Measures

The necessity of surgery in breast masses of female adolescents.

Results

10 female patients with an average age of 14 years were operated on for breast masses. A palpable mass in the breast and social anxiety were the cardinal complaints. Two patients had a family history of breast carcinoma. One patient had a history of neuroblastoma in remission. Histopathologic examination revealed 3 juvenile fibroadenomas, 1 conventional fibroadenoma, 3 tubular adenomas, and 3 phyllodes tumors.

Conclusions

Palpable breast masses in adolescents are uncommon and are usually benign. The low malignancy risk and rarity of breast masses in childhood create a controversy as how to manage breast masses. Ultrasonography is the initial imaging modality to define the characteristics of the breast mass. Excisional biopsy and histopathologic examination is essential to rule out rare, but probable malignant, lesions in adolescents in selected patients such as maternal history of breast carcinoma, previous malignancy history in the patient, big size of the mass, and no regression on follow-up.

Introduction

Breast masses are not common in adolescents and are rarely malignant.1, 2, 3 The most common benign neoplastic breast lesion in female adolescents is fibroadenoma (FA), accounting for 54-94% of adolescent breast pathology.1, 2, 3, 4, 5 Phyllodes tumors (PT) of the breast are unusual fibroepithelial tumors that exhibit a wide range of clinical behavior with the structural similarity to the FA.¹

Increased awareness of breast cancer has provided an accumulation of knowledge about the characteristics and management of breast masses. Psychological stress on the patients and their families is the cardinal complaint for coming to the hospital in developing countries. The physicians are obliged to evaluate young patients with breast masses and related symptoms in a timely manner with an appropriate work-up and should decide the timing of surgery. There are controversies among pediatric surgeons in supporting the conservative or the operative approach. There is a tendency toward a conservative approach owing to the rarity of malignancy in this age group. The purpose of this study was to describe our management for breast masses and to evaluate histopathologic results in surgically treated breast masses of our patients in this age group.

Section snippets

Material and Methods

One hundred fifty-nine female adolescent patients were presented with a breast mass between March 2003 and May 2011 in our hospital. Most of patients were not operated on because of stable size or resolution of the mass by clinical exam. The demographic and clinical data of 10 adolescent female patients who required surgical excision for solid breast masses in an 8-year period were reviewed. Their cardinal symptoms and signs, duration of symptoms, family history of breast cancer, and history of

Results

A total of 10 female patients underwent surgery for breast masses (Table 1). The mean age of the patients was 14.5 ± 2.1 years. All patients were healthy adolescents, no one had endocrinological disease and all were presented with a palpable breast mass recognized by the patient herself. The onset of the symptoms varied from 2 days to 2 years (median, 37.5 days). A palpable mass in the breast was the main complaint in all patients. There was no history of the trauma or consumption of

Discussion

Pathologic conditions of the breast are rare and predominantly benign in adolescents. It is reported that patients rarely can present with primary malignancy or metastatic disease.⁶ Breast cancer in childhood accounts for less than 0.1% of all breast cancers and less than 1% of childhood cancers.⁷ Fibroadenoma is the most common benign neoplasm and accounts for 54%–94% of all breast masses in adolescent females.1, 2, 3, 4, 5 There are controversies on the management of suspected or diagnosed

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Cited by (33)

The limited role of ultrasound in the surgical assessment of solid pediatric breast lesions
2021, Clinical Imaging
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).
A single institutional retrospective analysis of patients aged ≤18 years who underwent breast mass resection was performed. Data was collected and analyzed using SPSS.
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.
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.
Use of breast imaging-reporting and data system (BI-RADS) ultrasound classification in pediatric and adolescent patients overestimates likelihood of malignancy
2021, Journal of Pediatric Surgery
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.
Pediatric and Adolescent Surgical Breast Clinic: Preliminary Experience
2020, Journal of Pediatric and Adolescent Gynecology
Citation Excerpt :
In addition, it can present a dilemma for the surgeon and sometimes lead to mistreatment. Some authors recommend clinical follow-up alone or with sonographic scans in most cases15–17; others recommend biopsy studies of any mass suggestive of malignancy and long-term follow-up for nonsuggestive masses3,17; still others recommend excision of any mass suggestive of malignancy,18,19 or masses that persist on long-term follow-up until age 35 years.19 The significance of the different categorization of breast masses in the pediatric and adult populations has hardly been discussed in the literature.20
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.
Retrospective, observational.
Pediatric Surgical Breast Clinic of Schneider Children's Medical Center of Israel.
Patients referred to the clinic during the first 18 months of its establishment.
Rate of breast masses, rate of malignancy, and types of evaluation and treatment.
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.
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.
A population-based analysis of pediatric breast cancer
2019, Journal of Pediatric Surgery
The purpose of this study was to evaluate trends in demographics and outcomes of pediatric breast cancer in a United States population-based cohort.
The Surveillance, Epidemiology, and End Results (SEER) database was utilized to identify all pediatric patients with malignant breast tumors between 1973 and 2014. Analysis was performed using Stata Statistical Software version 13.1. Associations between categorical variables were made using X² test. Log-rank test was used for univariate survival analysis. Kaplan–Meier analysis investigated five-year survival rates across several variables. Adjusted analysis was performed using a Cox Proportional-Hazards regression.
134 patients with breast malignancies were identified. Carcinoma was the most prevalent histology (48.5%), followed by fibroepithelial tumors (FETs) (35.1%), and sarcoma (14.2%). FETs were twice as common in black compared to nonblack patients (56.3% vs. 29.0%, p < 0.01). Analyzing histology by stage revealed that 100% of FETs were early stage disease (p < 0.0001). 46.7% of the tumors tested were ER/PR negative, more than twice as many compared to the published adult estimate of 20.0%. Unadjusted survival analysis revealed worse survival for patients with adenocarcinoma/sarcomas, advanced stage, and high grade disease, without a survival difference between races.
Breast cancer remains a rare malignancy among pediatric patients. Although black patients were found to have more noncarcinomatous tumors with less advanced disease, this did not confer a survival advantage.
Retrospective cohort study.
Level III.
Giant breast fibroadenomas in adolescents: Diagnostic and therapeutic procedures
2018, Anales de Pediatria
Case Report and Review of Adolescent Atypical Ductal Hyperplasia and Juvenile Fibroadenoma: How Do We Assess and Manage Future Risk?
2018, Clinical Breast Cancer
Citation Excerpt :
Although fibroadenomas are benign lesions, there has been controversy with regard to their risk of developing into a malignant or premalignant lesion. Some studies have postulated that fibroadenomas may be associated with an increased risk of breast cancer, especially in the presence of atypical ductal hyperplasia (ADH), which has been characterized as a premalignant lesion.1 On the other hand, another retrospective study showed that within a cohort of 1834 women, the presence of either ADH or atypical lobular hyperplasia confined to a fibroadenoma was not a clinically significant risk factor in the development of breast cancer.2

View all citing articles on Scopus

: The authors indicate no conflicts of interest.

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Original StudySurgical Treatment of the Solid Breast Masses in Female Adolescents

Abstract

Study Objective

Design

Setting

Participants

Main Outcome Measures

Results

Conclusions

Introduction

Section snippets

Material and Methods

Results

Discussion

Breast

J Pediatr Surg

Eur J Cancer

Pediatr Neonatol

J Pediatr Surg

J Pediatr Adolesc Gynecol

J Pediatr Surg

J Pediatr Surg

Surgical breast lesions in adolescent females

Pediatr Surg Int

Disorder of the breast

Surgical breast lesions in adolescent patients and review of the literature

Acta Chir Belg

Original Study
Surgical Treatment of the Solid Breast Masses in Female Adolescents