Purpose or Case Report: Appropriate imaging evaluation and management of pediatric patients with breast symptoms is important to avoid recommending unnecessary imaging follow-up or invasive procedures that cause stress for patients and their caregivers and potential damage to the developing breast. Current practice parameters focus on adults, and there is no evidence-based consensus statement from professional societies to guide management specifically for pediatric breast masses. The objective of this study was to determine the diagnostic performance and outcomes of breast imaging in our pediatric patient population and further contribute to evidence guiding management for this clinical scenario.
Methods & Materials: This IRB-approved retrospective study was performed at a large academic medical institution with both adult and pediatric subspecialty imaging, where patients 10 years or older with breast symptoms are evaluated by breast imaging radiologists. An imaging database search was performed to identify patients less than 18 years old who underwent imaging for breast symptoms between 2013 to 2023. Patients were included in the study if initial imaging evaluation was performed at our institution during the study date range. Imaging BI-RADS assessment categories, initial management, follow-up, and final diagnoses were abstracted from the electronic medical record system. Final outcomes were based on clinical resolution of initial symptoms and signs, completion of imaging or clinical follow-up (up to 24 months), or tissue diagnosis (imaging-guided or excisional biopsy).
Results: A total of 417 patients (340 females, 77 males; mean age 14 years old; age range 0 to 17 years) met inclusion criteria. Two patients had a personal history of non-breast cancer (medulloblastoma and leukemia, respectively), and 114 patients had a family history of cancer. The most common imaging indications were palpable lump (n=340) and pain (n=143). Ultrasound (n=425) was the primary imaging modality. Initial imaging assessments were 24% (101/429) BI-RADS 1, 24% (101/429) BI-RADS 2, 19% (81/429) BI-RADS 3, and 8.6% (37/429) BI-RADS 4A. 21 cases were assigned BI-RADS 4A on follow-up imaging. The most frequent pathology from core needle biopsy (25/37) or surgical excision (15/27) was fibroadenoma. In 323 cases with clinical/imaging follow-up or tissue diagnosis, there were no malignancies.
Conclusions: Consideration of BI-RADS 3 assessment may be an appropriate alternative to biopsy in most pediatric patients.