Breast US in Children and Adolescents

Abstract

Ultrasonography (US) is of value in the evaluation and characterization of breast masses in children. Most masses represent either normal breast tissue, cysts, or fibroadenomas. Premature thelarche may be unilateral, and normal breast tissue is found at US. Cysts are commonly retroareolar; when they become infected, they appear sonographically as a complex mass. Fibroadenoma is the most frequent breast tumor in adolescent girls, and it is usually solitary, homogeneous, and hypoechoic. Malignant breast lesions are very rare in children; most are due to metastatic disease secondary to rhabdomyosarcoma, leukemia, lymphoma, and neuroblastoma, and their US appearance is nonspecific. Gynecomastia in boys can be mimicked by general obesity and pectoral hypertrophy; US is helpful in the diagnosis, especially when gynecomastia is asymmetric. Most breast lesions in children and adolescents are benign, and surgery should be avoided to prevent later deformity. US is the ideal imaging modality to evaluate breast lesions and may be used to guide a fine-needle aspiration biopsy. Color Doppler US evaluation is helpful; cysts are avascular, fibroadenomas may be avascular or hypovascular, and abscesses show peripheral increased flow. Bloody nipple discharge is more common in prepubertal patients, may occur in infants, and may be secondary to mammary ductal ectasia. Discharge commonly resolves spontaneously, and findings at US are frequently normal.

Assessment of vascularity with color Doppler ultrasound in gynecomastia

“…Physiologic gynecomastia most commonly occurs in three groups of patients: neonates, pubertal adolescents, and the elderly. It lasts a few months in the majority of individuals (2,7,8). In most cases, gynecomastia is a benign finding; however, it can be associated with pathological processes such as testicular tumors or hyperthyroidism.…”

“…Gray-scale US is therefore the most important diagnostic tool (7,12) and the method of choice for confirming the presence of breast tissue and characterizing abnormalities (6).…”

“…We found that the retroareolar region was the most vascular area (69%), followed by the lateral region (54%), indicating that arterial flow development parallels glandular tissue development in the breast. US can reveal histological changes in this manner, and characteristic sonographic findings for the classification of gynecomastia (Table 1) have been reported (7). However, this sonographic classification with gray-scale US data does not take into consideration the vascular structures of the breast.…”

“…Gynecomastia begins approximately one year after the onset of puberty and lasts only a few months (sometimes 2 years) in the majority of individuals (2,7,8). A spontaneous resolution of gynecomastia can be expected once the diagnosis is made.…”

Breast diseases in children: the spectrum of radiologic findings in a cohort study

“…Findings were considered "normal" in case of: a) no remarkable US findings in males, b) no remarkable US findings in girls <8 years of age, and c) only fibroglandular tissue in girls >8 years of age (peripubertal and adolescents girls). We did not use the US findings compatible with the stage of thelarche adopted from Tanner's classification, since this kind of evaluation would not contribute to our purpose (2,5,6).…”