Assessment of pediatric breast ultrasound less is more: a practical imaging approach

Background: Breast cancer in pediatric patients is rare, but ultrasound (US) is widely utilized for symptomatic cases. Purpose: To determine biopsy and cancer detection rates of pediatric patients and to assess if breast US can be omitted. Material and Methods: A retrospective review of a 5-year period was conducted of single-center breast US performed in patients aged <19 years. Data regarding presentation, clinical opinion (P1–5 score), and US (U1–5 score) were collected. If biopsy or surgery was performed, pathology was reviewed (B1–5 score). Results: In total, 579 patients were included (19 boys, 560 girls; mean age=16.2±1.9 years; age range=0–18 years). Clinical examination was normal or benign (P1/P2) in all boys (100%) and 557/560 (99.5%) girls, and P3 in 3 (0.5%) girls. Of US, 52% demonstrated normal findings (U1) for both sexes (300/579); in the remaining cases, the most frequent findings were gynecomastia in 12/19 boys and well-defined breast masses in 208/560 girls. Of the 560 girls, 6 (1%) underwent US-guided biopsy, with final histology of fibroadenoma (B2) in all cases, while 27 (5%) had a surgical excision, with final histology of fibroadenoma (22/27, 81.5%), hamartoma (2/27, 7.4%), benign phyllodes tumor (2/27, 7.4%), and angiomyxoma skin lesion (1/27, 3.7%). No malignant lesions were diagnosed at the time of clinical referral or during the 18-month follow-up in patients with a well-defined mass on US. Conclusion: Breast malignancy is extremely rare in pediatric population. US can be safely omitted if clinical examination is normal; this approach would have avoided breast US in 52% of patients in this study.