McLaughlin Cory M, Gonzalez-Hernandez Jessica, Bennett Monica, Piper Hannah G
Department of Surgery, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas.
Office of the Chief Quality Officer, Baylor Scott & White Health, Dallas, Texas.
J Surg Res. 2018 Aug;228:247-252. doi: 10.1016/j.jss.2018.03.056. Epub 2018 Apr 12.
Pediatric breast masses can be a diagnostic challenge. Nearly all are benign, but there is no consensus on which should be removed. We hypothesized that children with asymptomatic breast lesions can be safely managed nonoperatively.
We performed a single-institution retrospective review of children (≤18 y) who underwent breast mass excision from 2008 to 2016. Male patients with gynecomastia and those who had needle biopsy without formal excision were excluded. Pearson correlation was used to compare ultrasound and pathologic size. Kruskal-Wallis test was used to compare size and final diagnosis.
One hundred ninety-six patients were included (96% female). Mean age was 15 ± 3 y. Most patients (71%) presented with a painless mass. Preoperative ultrasound was obtained in 70%. Pathology included fibroadenoma (81.5%), tubular adenoma (5%), benign phyllodes tumor (3%), benign fibroepithelial neoplasm (0.5%), and other benign lesions (10%). There were no malignant lesions. Ultrasound size had a Pearson correlation of 0.84 with pathologic size (P < 0.0001). There was no association between the size and final diagnosis.
Over 9 y, all pediatric breast masses removed at a single center were benign, most commonly fibroadenoma. Ultrasound was an accurate predictor of size, but large lesions did not necessarily confer a high malignancy risk. Observation is appropriate for asymptomatic breast masses in children. Decision for surgery should be individualized and not based on size alone.
小儿乳腺肿块的诊断颇具挑战。几乎所有肿块都是良性的，但对于哪些肿块应予以切除尚无共识。我们推测，无症状乳腺病变的儿童可以安全地进行非手术治疗。
我们对2008年至2016年接受乳腺肿块切除术的18岁及以下儿童进行了单机构回顾性研究。排除患有男性乳房发育症的男性患者以及那些仅接受针吸活检而未进行正式切除的患者。采用Pearson相关性分析比较超声测量大小与病理大小。使用Kruskal-Wallis检验比较肿块大小与最终诊断结果。
共纳入196例患者（96%为女性）。平均年龄为15±3岁。大多数患者（71%）表现为无痛性肿块。70%的患者术前行超声检查。病理结果包括纤维腺瘤（81.5%）、管状腺瘤（5%）、良性叶状肿瘤（3%）、良性纤维上皮性肿瘤（0.5%）和其他良性病变（10%）。未发现恶性病变。超声测量大小与病理大小的Pearson相关系数为0.84（P<0.0001）。肿块大小与最终诊断结果之间无关联。
在9年多的时间里，单一中心切除的所有小儿乳腺肿块均为良性，最常见的是纤维腺瘤。超声是肿块大小的准确预测指标，但大肿块不一定具有高恶性风险。对于儿童无症状乳腺肿块，观察是合适的。手术决策应个体化，而不应仅基于肿块大小。
