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Pediatric Surgery International

, Volume 34, Issue 6, pp 679–685 | Cite as

Analysis of factors predicting surgical intervention and associated costs in pediatric breast masses: a single center study

  • E. Graham Englert
  • Guillermo Ares
  • Andrea Henricks
  • Karen Rychlik
  • Catherine J. Hunter
Original Article

Abstract

Purpose

Finding a breast mass in a child provokes apprehension in parents, especially in those with a family history of breast cancer. Clinicians must decide between serial imaging or biopsy of the mass. Herein, we identify management differences in those with and without a positive family history, as well as identify cost differences.

Methods

An institutional retrospective review was performed of patients (2–18 years of age) with a diagnosis of breast mass. Patient demographics, presentation, medical and surgical history, physical exam, imaging, and pathologic diagnosis were collected. Cost data were acquired from the pediatric health information system (PHIS). Costs were compared between patients managed by biopsy versus serial ultrasounds. Bivariate analyses including Pearson’s Chi-square, student’s t tests, and logistic regression were performed.

Results

The probability of biopsy increases with age (p = 0.0001) and female gender (p = 0.006). Biopsy rate is higher for larger masses (p < 0.0001), growing size (p < 0.0001), and in patients with a positive family history of breast cancer (p < 0.0001). The average cost of care for management with initial excisional biopsy was $4491 versus those with serial ultrasounds ($986) (p < 0.0001).

Conclusions

In patients with small lesions, even with a family history of breast cancer, non-operative monitoring is a safe and cost-effective alternative to invasive biopsy.

Keywords

Breast mass Pediatric Ultrasound Cost Breast cancer 

Notes

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

No disclosures from the authors.

References

  1. 1.
    Simmons PS (2001) Breast disorders in adolescent females. Curr Opin Obstet Gynecol 13(5):459–461CrossRefPubMedGoogle Scholar
  2. 2.
    Simmons PS, Jayasinghe YL, Wold LE, Melton LJ 3rd (2011) Breast carcinoma in young women. Obstet Gynecol 118(3):529–536CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Kerlikowske K, Smith-Bindman R, Ljung BM, Grady D (2003) Evaluation of abnormal mammography results and palpable breast abnormalities. Ann Intern Med 139(4):274–284CrossRefPubMedGoogle Scholar
  4. 4.
    Kennedy RD, Boughey JC (2013) Management of pediatric and adolescent breast masses. Semin Plast Surg 27(1):19–22CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Neinstein LS, Atkinson J, Diament M (1993) Prevalence and longitudinal study of breast masses in adolescents. J Adolesc Health 14(4):277–281CrossRefPubMedGoogle Scholar
  6. 6.
    Gutierrez JC, Housri N, Koniaris LG, Fischer AC, Sola JE (2008) Malignant breast cancer in children: a review of 75 patients. J Surg Res 147(2):182–188CrossRefPubMedGoogle Scholar
  7. 7.
    Bobo JK, Lee NC, Thames SF (2000) Findings from 752,081 clinical breast examinations reported to a national screening program from 1995 through 1998. J Natl Cancer Inst 92(12):971–976CrossRefPubMedGoogle Scholar
  8. 8.
    Harth S, Behrens C, Roller FC, Alzen GF, Krombach GA (2016) Breast ultrasonography: findings in pediatric patients. Ultraschall Med 38(5):500–507PubMedGoogle Scholar
  9. 9.
    Weinstein SP, Conant EF, Orel SG, Zuckerman JA, Bellah R (2000) Spectrum of US findings in pediatric and adolescent patients with palpable breast masses. Radiographics 20(6):1613–1621CrossRefPubMedGoogle Scholar
  10. 10.
    Gao Y, Saksena MA, Brachtel EF, ter Meulen DC, Rafferty EA (2015) How to approach breast lesions in children and adolescents. Eur J Radiol 84(7):1350–1364CrossRefPubMedGoogle Scholar
  11. 11.
    Valeur NS, Rahbar H, Chapman T (2015) Ultrasound of pediatric breast masses: what to do with lumps and bumps. Pediatr Radiol 45(11):1584–1599 (quiz 1–3)CrossRefPubMedGoogle Scholar
  12. 12.
    Bock K, Duda VF, Hadji P, Ramaswamy A, Schulz-Wendtland R, Klose KJ et al (2005) Pathologic breast conditions in childhood and adolescence: evaluation by sonographic diagnosis. J Ultrasound Med 24(10):1347–1354 (quiz 56–7) CrossRefPubMedGoogle Scholar
  13. 13.
    Arca MJ, Caniano DA (2004) Breast disorders in the adolescent patient. Adolesc Med Clin 15(3):473–485CrossRefPubMedGoogle Scholar
  14. 14.
    Sanchez R, Ladino-Torres MF, Bernat JA, Joe A, DiPietro MA (2010) Breast fibroadenomas in the pediatric population: common and uncommon sonographic findings. Pediatr Radiol 40(10):1681–1689CrossRefPubMedGoogle Scholar
  15. 15.
    Cant PJ, Madden MV, Coleman MG, Dent DM (1995) Non-operative management of breast masses diagnosed as fibroadenoma. Br J Surg 82(6):792–794CrossRefPubMedGoogle Scholar
  16. 16.
    Collaborative Group on Hormonal Factors in Breast C (2001) Familial breast cancer: collaborative reanalysis of individual data from 52 epidemiological studies including 58,209 women with breast cancer and 101,986 women without the disease. Lancet 358(9291):1389–1399CrossRefGoogle Scholar
  17. 17.
    Ezer SS, Oguzkurt P, Ince E, Temiz A, Bolat FA, Hicsonmez A (2013) Surgical treatment of the solid breast masses in female adolescents. J Pediatr Adolesc Gynecol 26(1):31–35CrossRefPubMedGoogle Scholar
  18. 18.
    Evans DG, Howell A (2007) Breast cancer risk-assessment models. Breast Cancer Res 9(5):213CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Neinstein LS (1999) Breast disease in adolescents and young women. Pediatr Clin N Am 46(3):607–629CrossRefGoogle Scholar
  20. 20.
    Lee M, Soltanian HT (2015) Breast fibroadenomas in adolescents: current perspectives. Adolesc Health Med Ther 6:159–163PubMedPubMedCentralGoogle Scholar
  21. 21.
    Chang DS, McGrath MH (2007) Management of benign tumors of the adolescent breast. Plast Reconstr Surg 120(1):13e–9eCrossRefPubMedGoogle Scholar
  22. 22.
    De Silva NK, Brandt ML (2006) Disorders of the breast in children and adolescents, part 2: breast masses. J Pediatr Adolesc Gynecol 19(6):415–418CrossRefPubMedGoogle Scholar
  23. 23.
    Centers for Disease C, Prevention (2012) Vital signs: racial disparities in breast cancer severity–United States, 2005–2009. MMWR Morb Mortal Wkly Rep 61(45):922–926Google Scholar
  24. 24.
    Pettinato G, Manivel JC, Kelly DR, Wold LE, Dehner LP (1989) Lesions of the breast in children exclusive of typical fibroadenoma and gynecomastia. A clinicopathologic study of 113 cases. Pathol Annu 24(Pt 2):296–328PubMedGoogle Scholar
  25. 25.
    White J, Kearins O, Dodwell D, Horgan K, Hanby AM, Speirs V (2011) Male breast carcinoma: increased awareness needed. Breast Cancer Res 13(5):219CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Siegel RL, Miller KD, Jemal A. Cancer Statistics (2017) CA Cancer J Clin 67(1):7–30CrossRefPubMedGoogle Scholar
  27. 27.
    Pruthi S, Jones KN, Boughey JC, Simmons PS (2012) Breast masses in adolescents: clinical pearls in the diagnostic evaluation. Am Fam Physician 86(4):325–326PubMedGoogle Scholar
  28. 28.
    Vargas HI, Vargas MP, Eldrageely K, Gonzalez KD, Burla ML, Venegas R et al (2005) Outcomes of surgical and sonographic assessment of breast masses in women younger than 30. Am Surg 71(9):716–719PubMedGoogle Scholar
  29. 29.
    Tea MK, Asseryanis E, Kroiss R, Kubista E, Wagner T (2009) Surgical breast lesions in adolescent females. Pediatr Surg Int 25(1):73–75CrossRefPubMedGoogle Scholar
  30. 30.
    Kapila K, Pathan SK, Al-Mosawy FA, George SS, Haji BE, Al-Ayadhy B (2008) Fine needle aspiration cytology of breast masses in children and adolescents: experience with 1404 aspirates. Acta Cytol 52(6):681–686CrossRefPubMedGoogle Scholar
  31. 31.
    Eisenhut CC, King DE, Nelson WA, Olson LC, Wall RW, Glant MD (1996) Fine-needle biopsy of pediatric lesions: a three-year study in an outpatient biopsy clinic. Diagn Cytopathol 14(1):43–50CrossRefPubMedGoogle Scholar
  32. 32.
    Smith GE, Burrows P (2008) Ultrasound diagnosis of fibroadenoma—is biopsy always necessary? Clin Radiol 63(5):511–515 (discussion 6–7) CrossRefPubMedGoogle Scholar
  33. 33.
    Michala L, Tsigginou A, Zacharakis D, Dimitrakakis C (2015) Breast disorders in girls and adolescents. Is there a need for a specialized service? J Pediatr Adolesc Gynecol 28(2):91–94CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • E. Graham Englert
    • 1
    • 2
  • Guillermo Ares
    • 1
    • 3
  • Andrea Henricks
    • 2
  • Karen Rychlik
    • 1
  • Catherine J. Hunter
    • 1
    • 2
  1. 1.Ann and Robert H. Lurie Children’s Hospital of ChicagoChicagoUSA
  2. 2.Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  3. 3.Department of SurgeryUniversity of Illinois at ChicagoChicagoUSA

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