Abstract P1-05-08: Assessment and Diagnosis of Breast Pathology in Young Women: What Can We Learn?
Authors: Ramirez Stephanie A. , Menegaz Brian A. , Roark Ashley , Bonefas Elizabeth , Sepulveda Karla A , Thompson Alastair M. , Carter Stacey 
Published: March 2023

Introduction: Women 30 years-old or older that present with a breast complaint typically receive a standard work-up, which includes a diagnostic mammogram ultrasound. Because women under 30 years-old have extremely dense breast tissue, the initial imaging work-up begins with ultrasound. The American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) describes and categorizes imaging findings using a standardized language to convey to non-radiologist physicians and patients the risk associated with a described breast lesion. Interpretation of the results can be problematic in young women (&lt; 18 y.o) that may undergo imaging at a pediatric facility, often without on-site breast imaging specialists and standard breast imaging protocols in place, including the usage of the BI-RADS lexicon. Appropriateness of biopsy and surgical management require careful consideration especially in a setting where the pathology is often benign. We describe our 5-year experience of 482 young women undergoing breast imaging at a single institution to identify key features characteristic of young women with malignant lesions.

Methods: A retrospective cohort study was conducted on all patients between the ages of 9-29 years old that presented to a breast imaging center for evaluation of a breast complaint from January 2017 through December 2021. Patients were identified via an Epic SlicerDicer query based on age and breast imaging procedure. A retrospective chart review was conducted on this cohort to capture demographic information (Table 1), medical history and family history. Information related to radiographic evaluation, biopsy procedures, and post-operative pathology was also recorded.

Results: Four hundred-eight two patients with mean age of 23.8 3.7 years were seen for a breast complaint at the imaging center, of which 462 underwent breast ultrasound (96.7%). A BI-RADS classification was assigned in 418 reports (87%). Fifty-eight patients (12%) had imaging at an outside facility before coming to our dedicated breast imaging center. The mean maximal dimension at presentation was 1.3 1.6 cm. A BI-RADS classification of 4 was assigned to 46 patients (9.6%). A core needle biopsy (CNB) was performed in 63 patients (13.1%). Seventy-seven patients (16%) underwent surgery. Of the patients undergoing surgery, 38 (49.4%) had a CNB prior to surgery and the mean pre-operative maximal dimension on ultrasound was 3.1 1.6. Reason for excision included: mass size (30.3%), symptoms (27.6%), biopsy result (21.1%) and growth (19.7%). Eight patients (12.7%) were found to have a malignancy on CNB. Fibroadenoma (64.5%) was the most common pathology after surgery. A phyllodes tumor was identified in 8 patients, of which 6 were benign (7.9%) and 2 were classified as borderline (2.6%); there were no malignant phyllodes in the cohort. The mean size for phyllodes lesions were 3.8 1.8 cm. Six of 8 patients had a malignant lesion on final surgical pathology (7.9%); the other 2 patients achieved a pathologic complete response (pCR). Details regarding malignant lesions can be found in Table 2.

Conclusions: While the American College of Radiology helps provide guidance for appropriate imaging evaluation in young women, there are no treatment algorithms that address the appropriateness of surgical treatment in this age group where the diagnosis is often benign. Radiologist and surgeons that specialize in breast disease may be asked to provide guidance on management decisions for a population they may rarely see (patients &lt; 18 years-old), just as pediatrician or pediatric surgeons may feel pressure to making management plans for complaints they rarely encounter (breast). The value of using standardized imaging and treatment protocols with dedicated breast radiologist and surgeons may offer the best comprehensive approach to this unique subset of patients and deserves further evaluation.

Table 1. Demographic and medical history. Values are n (%) or median [interquartile range]; BMI, body mass index

Table 2. Characteristics of masses in young women. Values are n (%) or median [interquartile range].; *including juvenile fibroadenoma; **benign cyst, ductal ectasia, normal breast tissue, and papilloma; independent t-test was used to compare means for continuous variables; Pearson’s chi-squared test was used for categorical data; BMI, body mass index; NS, not significant

Citation Format: Stephanie A. Ramirez, Brian A. Menegaz, Ashley Roark, Elizabeth Bonefas, Karla A Sepulveda, Alastair M. Thompson, Stacey Carter. Assessment and Diagnosis of Breast Pathology in Young Women: What Can We Learn? [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-05-08.