1 Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390.
2 Solis Mammography, Houston, TX.
AJR Am J Roentgenol. 2019 Feb;212(2):450-455. doi: 10.2214/AJR.17.19482. Epub 2018 Nov 26.
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.
All pediatric breast ultrasound examinations performed 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.
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.
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.
本研究旨在描述我们在一家三级儿科医疗机构对经病理证实的乳腺肿块的经验，回顾已发表的治疗策略，并为儿科人群提出新的治疗建议。
回顾了在专门的儿科机构进行的为期 4 年的所有儿科乳腺超声检查。记录具有纤维腺瘤特征的实性肿块的最大测量值。随后回顾了对接受活检的患者的后续治疗和组织病理学发现，并将治疗策略与已发表的建议进行了比较。
在 277 个具有纤维腺瘤特征的乳腺肿块中，有 115 个（42%）进行了病理评估。均为良性；107 个为单纯性纤维腺瘤，4 个为幼年性纤维腺瘤，3 个为良性叶状肿瘤，1 个为颗粒细胞瘤。单纯性纤维腺瘤大小为 0.9 至 9.1cm，与幼年性纤维腺瘤和叶状肿瘤（范围 1.7-12.5cm）相比在大小上有统计学显著差异。在组织诊断前进行的 47 个超声随访肿块均为纤维腺瘤；其中 5 个显示间隔生长 50%或以上。回顾性应用已发表的儿科乳腺管理标准对检测非单纯性纤维腺瘤肿块的敏感性没有差异。
根据大小和间隔增长率，对超声表现类似于纤维腺瘤的小儿乳腺肿块的治疗可以基于此。不建议对具有纤维腺瘤特征的超声肿块常规进行手术切除或活检。
