Purpose or Case Report: The purpose of this exhibit is to demonstrate the characteristic sonographic appearance of benign masses in the pediatric population in order to address the wide variation in management of palpable, hypoechoic, circumscribed masses seen on ultrasound. Currently, management includes fine needle aspiration/core needle biopsy, excision, imaging follow-up, and reassurance. This exhibit proposes guidelines for management of palpable pediatric breast masses with ultrasound findings most suggestive of fibroadenomas.
Methods & Materials: At our facility, 1214 de-identified ultrasound cases over a 4-year period were retrospectively analyzed. Two hundred fifty cases of pediatric breast masses with ultrasound features suggestive of fibroadenomas were identified and subsequent management, if any, was reviewed.
Results: In all patients undergoing biopsy for a palpable breast mass (n=88), pathology demonstrated a benign histology, most commonly fibroadenoma. Phyllodes tumor was demonstrated in only two cases and both were benign. Remaining patients (n=162) were followed clinically or with routine imaging. In patients who underwent follow-up imaging prior to biopsy, growth of the mass had no bearing on its benignity in our patient population.
Conclusions: All pediatric breast masses with typical benign sonographic features and pathologic correlation demonstrated a benign tissue diagnosis, most commonly fibroadenoma. We therefore recommend that solid breast masses with imaging features typical of fibroadenoma be conservatively managed unless symptomatic or the mass demonstrates rapid growth on physical exam. Routine follow-up imaging and biopsy (fine needle aspiration or core biopsy) are not recommended as they are unlikely to alter management.