Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Breast Lesions in Children and Adolescents: Diagnosis and Management

  • Lee, Eun Ji (Department of Radiology, Soonchunhyang University Seoul Hospital) ;
  • Chang, Yun-Woo (Department of Radiology, Soonchunhyang University Seoul Hospital) ;
  • Oh, Jung Hee (Department of Radiology, Soonchunhyang University Seoul Hospital) ;
  • Hwang, Jiyoung (Department of Radiology, Soonchunhyang University Seoul Hospital) ;
  • Hong, Seong Sook (Department of Radiology, Soonchunhyang University Seoul Hospital) ;
  • Kim, Hyun-joo (Department of Radiology, Soonchunhyang University Seoul Hospital)
  • Received : 2018.01.25
  • Accepted : 2018.04.04
  • Published : 2018.10.01
⟨ Previous Next ⟩

Abstract

Pediatric breast disease is uncommon, and primary breast carcinoma in children is extremely rare. Therefore, the approach used to address breast lesions in pediatric patients differs from that in adults in many ways. Knowledge of the normal imaging features at various stages of development and the characteristics of breast disease in the pediatric population can help the radiologist to make confident diagnoses and manage patients appropriately. Most breast diseases in children are benign or associated with breast development, suggesting a need for conservative treatment. Interventional procedures might affect the developing breast and are only indicated in a limited number of cases. Histologic examination should be performed in pediatric patients, taking into account the size of the lesion and clinical history together with the imaging findings. A core needle biopsy is useful for accurate diagnosis and avoidance of irreparable damage in pediatric patients. Biopsy should be considered in the event of abnormal imaging findings, such as non-circumscribed margins, complex solid and cystic components, posterior acoustic shadowing, size above 3 cm, or an increase in mass size. A clinical history that includes a risk factor for malignancy, such as prior chest irradiation, known concurrent cancer not involving the breast, or family history of breast cancer, should prompt consideration of biopsy even if the lesion has a probably benign appearance on ultrasonography.

Keywords

Acknowledgement

Supported by : Soonchunhyang University

References

  1. Valeur NS, Rahbar H, Chapman T. Ultrasound of pediatric breast masses: what to do with lumps and bumps. Pediatr Radiol 2015;45:1584-1599; quiz 1581-1583 https://doi.org/10.1007/s00247-015-3402-0
  2. Chung EM, Cube R, Hall GJ, Gonzalez C, Stocker JT, Glassman LM. From the archives of the AFIP: breast masses in children and adolescents: radiologic-pathologic correlation. Radiographics 2009;29:907-931 https://doi.org/10.1148/rg.293095010
  3. Garcia CJ, Espinoza A, Dinamarca V, Navarro O, Daneman A, Garcia H, et al. Breast US in children and adolescents. Radiographics 2000;20:1605-1612 https://doi.org/10.1148/radiographics.20.6.g00nv171605
  4. Kronemer KA, Rhee K, Siegel MJ, Sievert L, Hildebolt CF. Gray scale sonography of breast masses in adolescent girls. J Ultrasound Med 2001;20:491-496; quiz 498 https://doi.org/10.7863/jum.2001.20.5.491
  5. Sanchez R, Ladino-Torres MF, Bernat JA, Joe A, DiPietro MA. Breast fibroadenomas in the pediatric population: common and uncommon sonographic findings. Pediatr Radiol 2010;40:1681-1689 https://doi.org/10.1007/s00247-010-1678-7
  6. Gutierrez JC, Housri N, Koniaris LG, Fischer AC, Sola JE. Malignant breast cancer in children: a review of 75 patients. J Surg Res 2008;147:182-188 https://doi.org/10.1016/j.jss.2008.03.026
  7. Kaneda HJ, Mack J, Kasales CJ, Schetter S. Pediatric and adolescent breast masses: a review of pathophysiology, imaging, diagnosis, and treatment. AJR Am J Roentgenol 2013;200:W204-W212 https://doi.org/10.2214/AJR.12.9560
  8. Gao Y, Saksena MA, Brachtel EF, terMeulen DC, Rafferty EA. How to approach breast lesions in children and adolescents. Eur J Radiol 2015;84:1350-1364 https://doi.org/10.1016/j.ejrad.2015.04.011
  9. Baker JA, Soo MS, Rosen EL. Artifacts and pitfalls in sonographic imaging of the breast. AJR Am J Roentgenol 2001;176:1261-1266 https://doi.org/10.2214/ajr.176.5.1761261
  10. Durmaz E, Oztek MA, Arioz Habibi H, Kesimal U, Sindel HT. Breast diseases in children: the spectrum of radiologic findings in a cohort study. Diagn Interv Radiol 2017;23:407-413 https://doi.org/10.5152/dir.2017.17033
  11. Bock K, Duda VF, Hadji P, Ramaswamy A, Schulz-Wendtland R, Klose KJ, et al. Pathologic breast conditions in childhood and adolescence: evaluation by sonographic diagnosis. J Ultrasound Med 2005;24:1347-1354; quiz 1356-1357 https://doi.org/10.7863/jum.2005.24.10.1347
  12. Youn I, Park SH, Lim IS, Kim SJ. Ultrasound assessment of breast development: distinction between premature thelarche and precocious puberty. AJR Am J Roentgenol 2015;204:620-624 https://doi.org/10.2214/AJR.14.12565
  13. Adler DD, Rebner M, Pennes DR. Accessory breast tissue in the axilla: mammographic appearance. Radiology 1987;163:709-711 https://doi.org/10.1148/radiology.163.3.3575719
  14. Mojallal A, La Marca S, Shipkov C, Sinna R, Braye F. Poland syndrome and breast tumor: a case report and review of the literature. Aesthet Surg J 2012;32:77-83 https://doi.org/10.1177/1090820X11430499
  15. Zhang F, Qi X, Xu Y, Zhou Y, Zhang Y, Fan L, et al. Breast cancer and Poland's syndrome: a case report and literature review. Breast J 2011;17:196-200 https://doi.org/10.1111/j.1524-4741.2010.01042.x
  16. Braunstein GD. Gynecomastia. N Engl J Med 1993;328:490-495 https://doi.org/10.1056/NEJM199302183280708
  17. Weinstein SP, Conant EF, Orel SG, Zuckerman JA, Bellah R. Spectrum of US findings in pediatric and adolescent patients with palpable breast masses. Radiographics 2000;20:1613-1621 https://doi.org/10.1148/radiographics.20.6.g00nv091613
  18. Huneeus A, Schilling A, Horvath E, Pinochet M, Carrasco O. Retroareolar cysts in the adolescent. J Pediatr Adolesc Gynecol 2003;16:45-49 https://doi.org/10.1016/S1083-3188(02)00238-3
  19. Welch ST, Babcock DS, Ballard ET. Sonography of pediatric male breast masses: gynecomastia and beyond. Pediatr Radiol 2004;34:952-957 https://doi.org/10.1007/s00247-004-1281-x
  20. Soo MS, Kornguth PJ, Hertzberg BS. Fat necrosis in the breast: sonographic features. Radiology 1998;206:261-269 https://doi.org/10.1148/radiology.206.1.9423681
  21. Simmons PS. Diagnostic considerations in breast disorders of children and adolescents. Obstet Gynecol Clin North Am 1992;19:91-102
  22. Stavros AT, Thickman D, Rapp CL, Dennis MA, Parker SH, Sisney GA. Solid breast nodules: use of sonography to distinguish between benign and malignant lesions. Radiology 1995;196:123-134 https://doi.org/10.1148/radiology.196.1.7784555
  23. Sanders LM, Sharma P, El Madany M, King AB, Goodman KS, Sanders AE. Clinical breast concerns in low-risk pediatric patients: practice review with proposed recommendations. Pediatr Radiol 2018;48:186-195 https://doi.org/10.1007/s00247-017-4007-6
  24. Patterson SK, Jorns JM. A case of juvenile papillomatosis, aka "Swiss cheese disease". Breast J 2013;19:440-441 https://doi.org/10.1111/tbj.12137
  25. Gill J, Greenall M. Juvenile papillomatosis and breast cancer. J Surg Educ 2007;64:234-236 https://doi.org/10.1016/j.jsurg.2007.03.007
  26. Tse GM, Niu Y, Shi HJ. Phyllodes tumor of the breast: an update. Breast Cancer 2010;17:29-34 https://doi.org/10.1007/s12282-009-0114-z
  27. Cecen E, Uysal KM, Harmancioglu O, Balci P, Kupelioglu A, Canda T. Phyllodes tumor of the breast in an adolescent girl. Pediatr Hematol Oncol 2008;25:79-82 https://doi.org/10.1080/08880010701773910
  28. Yabuuchi H, Soeda H, Matsuo Y, Okafuji T, Eguchi T, Sakai S, et al. Phyllodes tumor of the breast: correlation between MR findings and histologic grade. Radiology 2006;241:702-709 https://doi.org/10.1148/radiol.2413051470
  29. Surov A, Holzhausen HJ, Wienke A, Schmidt J, Thomssen C, Arnold D, et al. Primary and secondary breast lymphoma: prevalence, clinical signs and radiological features. Br J Radiol 2012;85:e195-e205 https://doi.org/10.1259/bjr/78413721
  30. Wienbeck S, Meyer HJ, Uhlig J, Herzog A, Nemat S, Teifke A, et al. Radiological imaging characteristics of intramammary hematological malignancies: results from a german multicenter study. Sci Rep 2017;7:7435 https://doi.org/10.1038/s41598-017-07409-z
  31. Kennedy RD, Boughey JC. Management of pediatric and adolescent breast masses. Semin Plast Surg 2013;27:19-22 https://doi.org/10.1055/s-0033-1343991
  32. Murphy JJ, Morzaria S, Gow KW, Magee JF. Breast cancer in a 6-year-old child. J Pediatr Surg 2000;35:765-767 https://doi.org/10.1053/jpsu.2000.6064
  33. Horowitz DP, Sharma CS, Connolly E, Gidea-Addeo D, Deutsch I. Secretory carcinoma of the breast: results from the survival, epidemiology and end results database. Breast 2012;21:350-353 https://doi.org/10.1016/j.breast.2012.02.013
  34. Ha SM, Chae EY, Cha JH, Kim HH, Shin HJ, Choi WJ. Association of BRCA mutation types, imaging features, and pathologic findings in patients with breast cancer with BRCA1 and BRCA2 mutations. AJR Am J Roentgenol 2017;209:920-928 https://doi.org/10.2214/AJR.16.16957
  35. Lee MV, Katabathina VS, Bowerson ML, Mityul MI, Shetty AS, Elsayes KM, et al. BRCA-associated cancers: role of imaging in screening, diagnosis, and management. Radiographics 2017;37:1005-1023 https://doi.org/10.1148/rg.2017160144
  36. Mendelson EB, Bohm-Velez M, Berg WA, et al. ACR BI-RADS ultrasound. In: ACR BI-RADS Atlas eds. Breast imaging reporting and data system, 5th ed. Reston, VA: American College of Radiology, 2013:128-130
  37. Gordon PB, Gagnon FA, Lanzkowsky L. Solid breast masses diagnosed as fibroadenoma at fine-needle aspiration biopsy: acceptable rates of growth at long-term follow-up. Radiology 2003;229:233-238 https://doi.org/10.1148/radiol.2291010282

Cited by

  1. Characteristics of Recent Articles Published in the Korean Journal of Radiology Based on the Citation Frequency vol.21, pp.12, 2020, https://doi.org/10.3348/kjr.2020.1322
  2. Malignant Phyllodes Tumor in an Adolescent Female: A Rare Case Report and Review of the Literature vol.2020, pp.None, 2018, https://doi.org/10.1155/2020/1989452
  3. Main Traits of Breast Fibroadenoma Among Adolescent Girls vol.35, pp.4, 2020, https://doi.org/10.1089/cbr.2019.3209
  4. Cyst of Montgomery: An uncommon adolescent breast lump vol.27, pp.2, 2018, https://doi.org/10.4103/jfcm.jfcm_288_19
  5. Focal Pathology of Mammary Glands in Teenage Girls vol.19, pp.4, 2018, https://doi.org/10.15690/vsp.v19i4.2139
  6. Breast lesions in women under 25 years: radiologic-pathologic correlation vol.51, pp.1, 2018, https://doi.org/10.1186/s43055-020-00209-y
  7. Breast complaints in children and the effect of family history vol.63, pp.3, 2018, https://doi.org/10.1111/ped.14418
  8. Patología mamaria infantil vol.56, pp.2, 2018, https://doi.org/10.1016/s1245-1789(21)45220-0
  9. A retrospective review of phyllodes tumors of the breast from a single institution vol.40, pp.suppl1, 2018, https://doi.org/10.3233/bd-219009
  10. Mammary Fibrocystic Change in a Pre-Pubertal child- A Case Report with a Histopathological Perspective vol.40, pp.5, 2021, https://doi.org/10.1080/15513815.2020.1721739