Breast Imaging in the Pediatric and Adolescent Patient
Sheila Venkatesh, MD
Donnette Dabydeen, MD
Rochester General Hospital
Department of Radiology
- Clinical indications for breast imaging are painful, palpable mass, unilateral, spontaneous, bloody or clear nipple discharge, and breast infection.
- Ultrasound is the primary imaging modality in the pediatric and adolescent patient.
- Ultrasound has a 99.5% negative predictive value in distinguishing between benign and malignant masses.
- Mammography is less sensitive due to increased breast density.
- For radiation exposure to be as low as reasonably achievable, mammography is only used only when necessary. Routine screening mammograms are not recommended.
- In patients with genetic mutations or strong family history, screening with breast MRI may be indicated.
- Can be single or multiple, simple or complex.
- Circumscribed margins, posterior acoustic enhancement, and thin walls on ultrasound.
- In adolescent patients, retroareolar cysts may be seen.
- Can follow up if needed with ultrasound.
- Benign, excessive subareolar breast tissue.
- Can be physiologic in neonates and pubertal boys.
- Can present as tender, mobile mass.
- Can present as ill-defined hypoechoic region in the retroareolar breast.
- Commonly seen in pediatric and adolescent patients.
- Mobile, painless mass.
- Circumscribed, hypoechoic, wider than tall orientation.
- Can present as bilateral giant juvenile fibroadenomas.
- Follow up with ultrasound, biopsy, or surgically excise.
- Epithelial-lined cyst filled with milk.
- Can be seen in lactating, adolescent female patients.
- On lateral mammogram, a fat-fluid level can be seen.
- On ultrasound, seen as complex cystic mass.
- Follow up with ultrasound or ultrasound-guided aspiration.
- Can present with erythema, warmth, and tenderness.
- Hypoechoic, complex fluid collection.
- Increased peripheral flow on color Doppler.
- Ultrasound-guided aspiration is diagnostic and therapeutic.
- Secondary to trauma or iatrogenic injuries.
- Complex cystic lesion that is initially hyperechoic.
- Becomes anechoic as the hematoma evolves.
- Follow up is recommended to ensure benign evolution.
- Orgiginates from specialized lobular connective tissue similar to fibroadenomas.
- May present as rapidly enlarging breast mass.
- Can be benign, borderline, or malignant histologically.
- Most common malignant breast mass in adolescents.
- Can appear similar to fibroadenomas on ultrasound especially in cases of giant juvenile fibroadenomas.
- Histologic examination can be used to differentiate between fibroadenoma and phyllodes tumor and to further categorize the phyllodes tumor.
- Treatment with surgical excision.
- Pseudoangiomatous stromal hyperplasia
- Benign proliferation of stroma; hypoechoic, well-circumscribed, and wider than tall on ultrasound; biopsy is recommended to ensure benignity.
- Intraductal papilloma
- Rare in this population; presents with spontaneous nipple discharge; found in subareolar region.
- Juvenile papillomatosis
- Rare, proliferative process; mobile, firm, well-circumscribed mass; surgical excision is recommended.
- Primary breast cancer
- Extremely rare and accounts for less than 1% of all childhood cancers.
- Most commonly reported type is secretory carcinoma.
- Metastatic disease
- Most common primaries are lymphoma, leukemia, and rhabdomyosarcoma.
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