D Ravichandran1, S Naz. 1. Breast Unit, Luton and Dunstable Hospital, Lewsey Road, Luton LU4 0DZ, Bedfordshire, United Kingdom. ravi_surgery@hotmail.com
Abstract
AIM: Children and adolescents referred to a rapid diagnosis breast clinic were analysed to study the conditions these patients were referred with, their management, and the final outcome. METHODS: All new patients aged 18 or under seen in a breast clinic over a 39-month period to June 2004 were identified and their case notes were reviewed. RESULTS: Among 6930 new referrals, 88 (1.3 %) were aged 18 or under and 86 patients were included in the study (median age 16 yrs, range 8 - 18 yrs). Five patients were aged less than 12 and were referred with physiological breast buds. In girls aged 13 - 18 years, most were referred for an apparent palpable abnormality. Thirty percent had a family history of breast carcinoma and 35 % were on the oral contraceptive pill. Thirty-three patients (38 %) had a clinical examination only. Others, in addition to the clinical examination, had an ultrasound (US) (n = 24, 28 %), fine needle aspiration cytology (FNAC)/core biopsy (CB) (n = 5, 6 %) or both US and FNAC/CB (triple assessment) (n = 24, 28 %). No malignant disease was found. No diagnostic biopsies were performed. Only 5 patients had surgery, four for fibroadenoma and one for sebaceous cyst. CONCLUSIONS: Patients aged 18 years or under do not constitute a major workload problem for rapid diagnosis breast clinics. Malignant disease remains rare. A significant proportion of patients require only clinical examination and reassurance. The diagnosis can usually be made without open biopsies and less invasively using FNAC or CB.
AIM: Children and adolescents referred to a rapid diagnosis breast clinic were analysed to study the conditions these patients were referred with, their management, and the final outcome. METHODS: All new patients aged 18 or under seen in a breast clinic over a 39-month period to June 2004 were identified and their case notes were reviewed. RESULTS: Among 6930 new referrals, 88 (1.3 %) were aged 18 or under and 86 patients were included in the study (median age 16 yrs, range 8 - 18 yrs). Five patients were aged less than 12 and were referred with physiological breast buds. In girls aged 13 - 18 years, most were referred for an apparent palpable abnormality. Thirty percent had a family history of breast carcinoma and 35 % were on the oral contraceptive pill. Thirty-three patients (38 %) had a clinical examination only. Others, in addition to the clinical examination, had an ultrasound (US) (n = 24, 28 %), fine needle aspiration cytology (FNAC)/core biopsy (CB) (n = 5, 6 %) or both US and FNAC/CB (triple assessment) (n = 24, 28 %). No malignant disease was found. No diagnostic biopsies were performed. Only 5 patients had surgery, four for fibroadenoma and one for sebaceous cyst. CONCLUSIONS:Patients aged 18 years or under do not constitute a major workload problem for rapid diagnosis breast clinics. Malignant disease remains rare. A significant proportion of patients require only clinical examination and reassurance. The diagnosis can usually be made without open biopsies and less invasively using FNAC or CB.