Surgical Approach to Childhood Breast Masses

Öz

Objective: We aimed to investigate the epidemiological and characteristic features of patients treated for breast masses in our clinic and share our experiences.

Material and Methods: Patient records were reviewed retrospectively. Demographic and clinical data were investigated. The patients were divided into those who were operated on at the first admission (group 1) and those who were operated on after the follow-up (group 2) and compared. The statistical analysis evaluated with SPSS version 21. p<0.05 was considered significant.

Results: Forty-eight patients who were operated on for breast mass in 10 years were included in the study. There was no difference between the groups regarding mean age and complaints at presentation (p=0.723, P=0.555, respectively). Ultrasound was performed on all patients. It was observed that the masses were located more frequently in the right breast in Group 1 (58.3%) and the left breast in Group 2 (p=0.386). In addition, it was noticed that the masses were most frequently located in the upper lateral quadrant of the breast in both groups (62.5% and 70.89%, respectively). The longest diameters of the masses were longer in group 1 than in group 2 (51.79±11.11 mm and 35.16±3.74 mm, respectively, p<0.001). Radiologically, most of the masses were reported as Breast Imaging Reporting and Data System (BI-RADS 3) in both groups (41.7% and 54.2%, respectively, p=0.444). Fine-needle aspiration biopsy (FNAB) was performed on nine patients in Group 1 and one in Group 2 (p=0.004). According to the FNAB reports, phyllodes tumors were detected in two patients, while the others were reported as fibroadenoma. The most common fibroadenomas were detected in the histopathological evaluations after surgical excision. In addition, a premalignant breast mass was detected in 6.2% of all patients.

Conclusion: We recommend surgical excision in children with large, rapidly growing breast masses or suspected phyllodes tumors.

Anahtar Kelimeler

• Breast masses
• Child
• Fibroadenoma
• Phyllodes tumor

Çocukluk Çağı Meme Kitlelerine Cerrahi Yaklaşım

Öz

Amaç: Kliniğimizde meme kitleleri nedeniyle tedavi edilen hastaların epidemiyolojik ve karakteristik özelliklerini araştırmayı ve deneyimlerimizi paylaşmayı amaçladık.

Gereç ve Yöntemler: Hasta kayıtları geriye dönük olarak incelendi. Demografik ve klinik veriler araştırıldı. Hastalar ilk başvuruda ameliyat edilenler (Grup 1) ve takip sonrası ameliyat edilenler (Grup 2) olarak ayrılarak karşılaştırıldı. İstatistiksel analiz SPSS 21 sürümü ile değerlendirildi. p<0.05 anlamlı kabul edildi.

Bulgular: Çalışmaya 10 yılda meme kitlesi nedeniyle ameliyat edilen 48 hasta dahil edildi. Ortalama yaş ve başvuru şikayetleri açısından gruplar arasında fark yoktu (sırasıyla p=0.723, p=0.555). Tüm hastalara ultrason yapıldı. Kitlelerin, Grup 1’de sağ memede (%58.3), Grup 2’de sol memede (p=0.386) daha sık yerleşim gösterdiği gözlendi. Ayrıca her iki grupta da kitlelerin en sık meme üst lateral kadranda yerleştiği görüldü (sırasıyla %62.5 ve %70.89). Kitlelerin uzun çapları grup 1’de grup 2’ye göre daha uzundu (sırasıyla 51.79±11.11 mm ve 35.16±3.74 mm, p<0.001). Radyolojik olarak her iki grupta da kitlelerin çoğu Breast Imaging Reporting and Data System (BI-RADS 3) olarak raporlandı (sırasıyla %41.7 ve %54.2, p=0.444). Grup 1’deki 9, Grup 2’deki 1 hastaya ince iğne aspirasyon biyopsisi (İİAB) yapıldı (p=0.004). İİAB ‘de iki hastada filloid tümör saptanırken, diğerleri fibroadenom olarak rapor edildi. Cerrahi eksizyon sonrası histopatolojik değerlendirmelerde en sık fibroadenom tespit edildi. Ayrıca tüm hastaların %6.2’sinde premalign meme kitlesi saptandı.

Sonuç: Çocuklarda, büyük boyutta, hızlı büyüyen veya filloid tümör şüphesi olan meme kitlelerinde cerrahi eksizyon öneriyoruz.

Anahtar Kelimeler

• Meme kitlesi
• Çocuk
• Fibroadenom
• Filloid Tümör

Kaynakça

1. Lawrence AE, Saito J, Onwuka A, Port E, Bowder A, Courtney C, et al. Management of Pediatric Breast Masses: A Multi-institutional Retrospective Cohort Study. J Surg Res 2021;264:309-15.
2. Gao Y, Saksena MA, Brachtel EF, terMeulen DC, Rafferty EA. How to approach breast lesions in children and adolescents. Eur J Radiol 2015;84:1350-64.
3. Simmons PSJO, America gcoN. Diagnostic considerations in breast disorders of children and adolescents. Obstet Gynecol Clin North Am 1992;19:91-102.
4. Santen RJ, Mansel R. Benign breast disorders. N Engl J Med 2005;353:275-85.
5. Simmons PS, Wold LEJA, Gynecology P. Surgically treated breast disease in adolescent females: a retrospective review of 185 cases. Adolesc Pediatr Gynecol 1989;2:95-8.
6. Hifny MA, A MY, R AG, Mohamed MA, Abdelhameid M. Application of periareolar mastopexy technique for giant phyllodes tumor resection in an adolescent female with breast asymmetry: a case report and literature review. J Egypt Natl Canc Inst 2020;32:27.
7. Lee EJ, Chang Y-W, Oh JH, Hwang J, Hong SS, Kim HJ. Breast lesions in children and adolescents: diagnosis and management. Korean J Radiol 2018;19:978-91.
8. Knell J, Koning JL, Grabowski JEJPsi. Analysis of surgically excised breast masses in 119 pediatric patients. Pediatr Surg Int 2016;32:93-6.

9. Jayasinghe Y, Simmons PS. Fibroadenomas in adolescence. Curr Opin Obstet Gynecol 2009;21:402-6.
10. Dogan G, Soyer T, Ekinci S, Karnak I, Ciftci AO, Tanyel FC. Evaluation of surgically treated breast masses in children. Turk J Pediatr 2017;59:177-83.
11. Englert EG, Ares G, Henricks A, Rychlik K, Hunter CJ. Analysis of factors predicting surgical intervention and associated costs in pediatric breast masses: a single center study. Pediatr Surg Int 2018;34:679-85.
12. Koning JL, Davenport KP, Poole PS, Kruk PG, Grabowski JEJJops. Breast Imaging-Reporting and Data System (BI-RADS) classification in 51 excised palpable pediatric breast masses. 2015;50:1746-50.
13. Jacklin RK, Ridgway PF, Ziprin P, Healy V, Hadjiminas D, Darzi A. Optimising preoperative diagnosis in phyllodes tumour of the breast. J Clin Pathol 2006;59:454-9.
14. 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;48:186-95.
15. Jawahar A, Vade A, Ward K, Okur G, Subbaiah P. Biopsy Versus Conservative Management of Sonographically Benign‐Appearing Solid Breast Masses in Adolescents. J Ultrasound Med 2015;34:617-25.
16. Chen WH, Cheng SP, Tzen CY, Yang TL, Jeng KS, Liu CL, et al. Surgical treatment of phyllodes tumors of the breast: retrospective review of 172 cases. J Surg Oncol 2005;91:185-94.
17. Brownstone ND, Celie K-B, Spigland NA, Otterburn DM. Pediatric Breast Fibroadenomas: A Systematic Review and Algorithm for Treatment. Ann Plast Surg 2019;83:601-5.
18. Gordon PB, Gagnon FA, Lanzkowsky LJR. Solid breast masses diagnosed as fibroadenoma at fine-needle aspiration biopsy: acceptable rates of growth at long-term follow-up. Radiology 2003;229:233-8.
19. Liberman L, Bonaccio E, Hamele-Bena D, Abramson AF, Cohen MA, Dershaw DD. Benign and malignant phyllodes tumors: mammographic and sonographic findings. Radiology 1996;198:121-4.