Management of palpable pediatric breast masses with ultrasound characteristics of fibroadenoma: A more conservative approach

OBJECTIVE. The purpose of this study is to describe our experience with pathologically proven breast masses at a tertiary care pediatric institution, review published management strategies, and propose new management recommendations for the pediatric population. MATERIALS AND METHODS. A ll p ediatric b reast u ltrasound examinations p erformed at a dedicated pediatric facility over a 4-year period were reviewed. Maximum measurements of solid masses with features of a fibroadenoma were recorded. The subsequent management and histopathologic findings for patients undergoing biopsy were reviewed, and management strategies were compared with published recommendations. RESULTS. Of 277 breast masses with features typical of fibroadenomas, 115 (42%) underwent pathologic evaluation. All were benign; there were 107 simple fibroadenomas, four juvenile fibroadenomas, three benign phyllodes tumors, and one granular cell tumor. Simple fibroadenomas ranged in size from 0.9 to 9.1 cm and were statistically significantly different in size compared with juvenile fibroadenomas and phyllodes tumors (range, 1.7-12.5 cm). All 47 masses undergoing follow-up ultrasound before tissue diagnosis were fibroadenomas; five showed 50% or greater interval growth. The retrospective application of published pediatric breast management criteria yielded no difference in sensitivity for the detection of nonsimple fibroadenoma masses. CONCLUSION. Management of pediatric breast masses resembling fibroadenomas at sonography can be based on size and interval growth rate. The routine performance of surgical excision or biopsy of masses with ultrasound characteristics typical of fibroadenomas is not recommended.