Ultrasound evaluation and outcome of breast masses in a cohort of pubertal children

OBJECTIVE: To describe the ultrasound evaluation and outcome of breast masses in a cohort of pubertal children. METHODS: A single institution, institutional review board-approved, retrospective study was performed including 13- to 18-year-old patients who had a breast ultrasound from January 1990 to December 2024. Clinical information and the ultrasound results were collected. Ultrasound was deemed positive if it explained the patients concern. Tissue sample was determined by the patient and ordering physician. Pathology results and follow-up ultrasounds were recorded as well. Descriptive analysis was performed. RESULTS: 240 patients (237 females) were included with a mean age of 17 years. The most common indication was a palpable mass (65%). 237 ultrasounds were positive (99%), 193 patients had a biopsy (80%). The most common diagnoses were fibroadenoma (69%), hamartoma (13%), and phyllodes tumor (7%). No primary or secondary breast malignancies were identified. 26 patients with a positive ultrasound and without a biopsy underwent sonographic surveillance, 20 patients had unchanged findings and 5 had decreased/resolved findings. CONCLUSION: The prevalence of malignant pediatric breast masses is exceedingly low. No malignant breast masses were found in our cohort; however, diagnosis should be suspected based on the clinical presentation and ultrasound appearance. The low percentage of malignant breast masses suggests sonographic surveillance and patient education are feasible and safe management approaches in most adolescent breast mass cases. ADVANCES IN KNOWLEDGE: This study provides one of the largest analyses of adolescent breast ultrasounds, showing that malignancy is exceedingly rare and supporting sonographic surveillance as a safe management approach.