Evaluation and Management of Adolescent Breast Masses: A Systematic Review From the American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee

Intoduction The evaluation and management of breast masses in the adolescent population is not standardized with most guidance extrapolated from adult data. We sought to review existing literature to inform practice in this unique population when presenting with a breast mass. Methods A systematic review of English language articles published between 1993 and 2024 was conducted to address management of adolescent patients (age 13 to 18 y) with breast masses: 1) What characteristics of breast masses prompt intervention? 2) Which surveillance strategies should be implemented if a biopsy is not pursued? and 3) What is the prognostic value of Breast Imaging Reporting and Data System (BI-RADS) classification of breast masses in adolescent patients? Results Of 9600 manuscripts initially identified, 11 met the inclusion criteria. Reporting of biopsy modality (incisional versus excisional) and indications was inconsistent across studies. A biopsy was most commonly pursued in the setting of an enlarging mass, large lesion size (>5 cm), nipple discharge, patient anxiety, or family history. Ultrasound was the primary imaging modality used; no patients underwent magnetic resonance imaging or mammography. Surveillance strategies varied widely. Given the low incidence of malignancy in adolescent patients, available data suggest BI-RADS classification may have limited applicability and may not accurately stratify cancer risk in this population. Conclusions Current evidence does not demonstrate a standardized approach to the evaluation of breast masses in adolescent patients and provides limited guidance regarding nonoperative surveillance strategies. Current literature supports the use of ultrasonography as the imaging modality of choice for adolescent breast masses, but frequency of surveillance is not well-defined. Adult BI-RADS classification is likely not appropriate for adolescents and warrants further study.