FIBROADENOMA IN THE PEDIATRIC PATIENT · 2019-04-12 · •A fibroadenoma is a non-cancerous breast...
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FIBROADENOMA IN THE PEDIATRIC PATIENT Ellen A. O’Donnell MSN, RN, CPNP-PC; Kelly Tierney MSN, RN, CPNP-PC; Caitlin Phinney MSN, RN, FNP-BC; Lindsay M. Lemire MSN, RN, FNP-BC Department of General Surgery, Boston Children’s Hospital, Boston, MA, USA BACKGROUND ASSESSMENT INTERVENTION NEXT STEPS REFERENCES [email protected] Educational Objectives: 1. Describe pathophysiology of fibroadenomas 2. Compare the management of fibroadenomas in the adult vs. pediatric populations 3. Create a formal family education sheet for distribution at initial surgical consultation Carrato, F., & Labow, B. (2013). Diagnosis and management of fibroadenomas in the adolescent breast. Seminars in Plastic Surgery, 27, 23-25. Glick,Y. & Jones, J. (2019). Fibroadenoma (breast). Radiopaedia. https://radiopaedia.org/articles/fibroadenoma-breast. Knell, J., Jeffery, K.L., & Grabowski, J. E. (2016). Analysis of surgically excised breast mass in 119 pediatric patients. Pediatric Surgery International, 32, 93-96. (Glick & Jones) , 2019 •Well circumscribed, mobile, rubbery, commonly upper outer quadrant •Average size 2-3cm Physical Exam •Nonspecific hypoechoic echotexture, round or oval, well circumscribed margins, three or fewer microlobulations, parallel orientation of the long axis with respect to the skin line •Doppler shows little to no vascularity Diagnostic Findings: Ultrasound •Posterior shadowing and angular margins (may indicate more concerning lesion such as phyllodes tumor or pseudoangiomatous stromal hyperplasia (PASH)). Unusual Features • A fibroadenoma is a non-cancerous breast mass that most often occurs in young women under the age of 30. • The mass consists of glandular and/or connective tissue. • They most often develop during puberty but can be found in women of any age. • They comprise 91-95 % of all solid breast masses in adolescent females less than 19 years of age. In the ambulatory surgery clinic at Boston Children’s Hospital (BCH) we have seen an increased incidence of young adolescent women with findings of a breast mass. Treatment methods among surgeons in our department vary. Many primary care offices initiate workup for this condition prior to a surgical consultation and may create unnecessary anxiety regarding the possible need for surgical intervention. We have identified the need to increase our knowledge regarding best practices surrounding the diagnosis, management and treatment for this condition. Fine needle aspiration/Core needle biopsy Pros: Confirms diagnosis Cons: -Disrupts developing breast tissue -High false negative rate due to sampling error -May require general anesthesia or sedative to complete procedure -Not recommended in the pediatric population Surgical excision (excisional biopsy) is the definitive method of diagnosis -Procedure performed under general anesthesia -Optimal incision is circumareolar or inframammary crease to decrease visible scaring Reasons for surgery: Symptomatic- patient experiencing pain or tenderness related to mass. Mass is hard, fixed to overlying skin, or nonmobile, and/or effecting ADLs. Large mass or rapid growth- Masses that are measuring >5cm can cause breast asymmetry and/or hypertrophy. Masses that increase >2cm in largest diameter in 3-6 month period Anxiety- Due to increased public awareness of breast cancer in adults, patients and families experience significant anxiety and prefer surgical removal. Conservative Approach: In recent study of 119 pediatric patients with breast masses, those treated with excisional biopsy all revealed benign pathology. If masses continue to be asymptomatic without other concerning features, continued observation as needed is appropriate. Complete regression occurs in 10-40% of these patients. • Develop and review family education/information materials • Design and implement a research driven study to further evaluate best care practices, management, and long term outcomes within BCH • Discuss standardization of care across our enterprise • Community outreach to clinicians to provide education regarding algorithm of care
Transcript of FIBROADENOMA IN THE PEDIATRIC PATIENT · 2019-04-12 · •A fibroadenoma is a non-cancerous breast...
FIBROADENOMA IN THE PEDIATRIC PATIENTEllen A. O’Donnell MSN, RN, CPNP-PC; Kelly Tierney MSN, RN, CPNP-PC; Caitlin Phinney MSN, RN, FNP-BC; Lindsay M. Lemire MSN, RN, FNP-BC
Department of General Surgery, Boston Children’s Hospital, Boston, MA, USA
BACKGROUND
ASSESSMENT
INTERVENTION
NEXT STEPS
REFERENCES
Educational Objectives:1. Describe pathophysiology of fibroadenomas2. Compare the management of fibroadenomas in the adult vs. pediatric populations3. Create a formal family education sheet for distribution at initial surgical
consultation
Carrato, F., & Labow, B. (2013). Diagnosis and management of fibroadenomas in the adolescent breast. Seminars in Plastic Surgery,
27, 23-25.
Glick,Y. & Jones, J. (2019). Fibroadenoma (breast). Radiopaedia. https://radiopaedia.org/articles/fibroadenoma-breast.
Knell, J., Jeffery, K.L., & Grabowski, J. E. (2016). Analysis of surgically excised breast mass in 119 pediatric patients. Pediatric Surgery
International, 32, 93-96.
(Glick & Jones) , 2019
•Well circumscribed, mobile, rubbery, commonly upper outer quadrant
•Average size 2-3cmPhysical Exam
•Nonspecific hypoechoic echotexture, round or oval, well circumscribed margins, three or fewer microlobulations, parallel orientation of the long axis with respect to the skin line
•Doppler shows little to no vascularity
Diagnostic Findings:
Ultrasound
•Posterior shadowing and angular margins (may indicate more concerning lesion such as phyllodes tumor or pseudoangiomatousstromal hyperplasia (PASH)).
Unusual Features
• A fibroadenoma is a non-cancerous breast mass that most often occurs in young women under the age of 30.
• The mass consists of glandular and/or connective tissue.• They most often develop during puberty but can be found in
women of any age.• They comprise 91-95 % of all solid breast masses in
adolescent females less than 19 years of age.
In the ambulatory surgery clinic at Boston Children’s Hospital (BCH) we have seen an increased incidence of young adolescent women with findings of a breast mass. Treatment methods among surgeons in our department vary. Many primary care offices initiate workup for this condition prior to a surgical consultation and may create unnecessary anxiety regarding the possible need for surgical intervention. We have identified the need to increase our knowledge regarding best practices surrounding the diagnosis, management and treatment for this condition.
Fine needle aspiration/Core needle biopsyPros: Confirms diagnosis Cons: -Disrupts developing breast tissue
-High false negative rate due to sampling error-May require general anesthesia or sedative to complete procedure-Not recommended in the pediatric population
Surgical excision (excisional biopsy) is the definitive method of diagnosis-Procedure performed under general anesthesia-Optimal incision is circumareolar or inframammary crease to decrease visible scaringReasons for surgery:Symptomatic- patient experiencing pain or tenderness related to mass. Mass is hard, fixed to overlying skin, or nonmobile, and/or effecting ADLs. Large mass or rapid growth- Masses that are measuring >5cm can cause breast asymmetry and/or hypertrophy. Masses that increase >2cm in largest diameter in 3-6 month period Anxiety- Due to increased public awareness of breast cancer in adults, patients and families experience significant anxiety and prefer surgical removal.
Conservative Approach: In recent study of 119 pediatric patients with breast masses, those treated with excisional biopsy all revealed benign pathology. If masses continue to be asymptomatic without other concerning features, continued observation as needed is appropriate. Complete regression occurs in 10-40% of these patients.
• Develop and review family education/information materials• Design and implement a research driven study to further evaluate best
care practices, management, and long term outcomes within BCH • Discuss standardization of care across our enterprise• Community outreach to clinicians to provide education regarding
algorithm of care
