Beyond size: the role of growth rate in managing adolescent breast masses.

INTRODUCTION

Adolescent breast masses are predominantly benign. Yet, distinguishing lesions that require intervention is critical. Current American Pediatric Surgical Association guidelines provide limited guidance for the management of masses <5 cm. The goal of this study was to develop a data-driven clinical management guideline for small adolescent breast masses.

METHODS

Growth dynamics were assessed in a retrospective cohort of female patients ≤21 years with breast masses using serial measurements, and risk-optimized growth threshold was derived using Youden's J statistic.

RESULTS

344 patients (median 19.6 years [IQR, 17.8-20.9]) with 435 breast masses were included. Most masses (430 [98.8%]) were <5 cm. Overall, 56 masses (12.8%) required intervention, including 3 malignancies (0.6%) and 53 hypercellular lesions (12.2%). A growth rate threshold >22.5%/3 months distinguished hypercellular from non-hypercellular lesions.

CONCLUSIONS

Among adolescent breast masses <5 cm, a growth rate threshold of 22.5%/3 months can be used for risk stratification and to guide selective intervention.