Wednesday, June 24, 2009

If an Adolescent Has a lump in her Breast, Does She Really Need a Biopsy?

Loyola Study Suggests Ultrasounds May be Sufficient in Many Cases

MAYWOOD -- If a lump is found in the breast of an adolescent girl, she often will undergo an excisional biopsy.

However, breast cancer is rare in adolescents, and the vast majority of teenage breast lumps turn out to be benign masses that are related to hormones.

A recent Loyola University Health System study published in the American Journal of Roentgenology suggests that a breast ultrasound examination might eliminate the need for biopsy in many cases.

Loyola radiologists performed ultrasound examinations on 20 girls ages 13 to 19 who had lumps in their breasts, including one girl who had a lump in each breast. The ultrasound studies indicated that 15 of the 21 lumps appeared to be benign, while and six were suspicious.

Follow-up biopsies or clinical examinations found that all 21 lumps were benign. These findings suggest that if a breast ultrasound finds nothing suspicious, the patient likely does not need to have an excisional biopsy, said lead author Dr. Aruna Vade, a professor in the Department of Radiology at Loyola University Chicago Stritch School of Medicine.

In an excisional biopsy, the surgeon makes an incision along the contour of the breast and removes the lump. However, this procedure can be painful, change the shape of the breast and leave a small scar.

Vade and her colleagues indicated that excisional biopsies should be reserved for solid breast masses that are suspicious or show progressive growth or masses that are found in patients who are known to have a primary malignant tumor or family history of cancer. Their study is published in the September, 2008 issue of the American Journal of Roentgenology.

Among girls younger than 19, there are fewer than 25 cases of breast cancer per 100,000 per year, according to the National Cancer Institute.

The vast majority of breast lumps in adolescents are benign and tend to wax and wane. Over time, many disappear. Many teenage girls undergo biopsy of breast lumps because of parental anxiety and surgeons' concerns, Vade said.

Vade and colleagues wrote that for adolescents who present with solid masses that appear benign on ultrasound examination, "we conclude that excisional biopsy may not always be necessary."

Vade's co-authors are Dr. Kathleen Ward, medical director of Women's Health Imaging, Loyola University Health System; Dr. Jennifer Lim-Dunham, clinical associate professor in the Department of Radiology, Loyola University Chicago Stritch School of Medicine; Dr. Davide Bova, assistant professor of radiology at Stritch and Dr. Vaishali Lafita, a radiology resident at Loyola University Medical Center.

About Loyola University Health System

Loyola University Health System (LUHS) is part of Trinity Health. Based in the western suburbs of Chicago, LUHS is a quaternary care system with a 61-acre main medical center campus, the 36-acre Gottlieb Memorial Hospital campus and more than 30 primary and specialty care facilities in Cook, Will and DuPage counties. Loyola University Medical Center’s campus is conveniently located in Maywood, 13 miles west of Chicago’s Loop and 8 miles east of Oak Brook, Ill. At the heart of the medical center campus is a 559-licensed-bed hospital that houses a Level 1 Trauma Center, a Burn Center and the Ronald McDonald® Children's Hospital of Loyola University Medical Center. Also on campus are the Cardinal Bernardin Cancer Center, Loyola Outpatient Center, Center for Heart & Vascular Medicine and Loyola Oral Health Center as well as Loyola University Chicago Stritch School of Medicine, Loyola University Chicago Marcella Niehoff School of Nursing and the Loyola Center for Fitness. Loyola's Gottlieb campus in Melrose Park includes the 255-licensed-bed community hospital, the Professional Office Building housing 150 private practice clinics, the Adult Day Care, the Gottlieb Center for Fitness, Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park.

Trinity Health is a national Catholic health system with an enduring legacy and a steadfast mission to be a transforming and healing presence within the communities we serve. Trinity is committed to being a people-centered health care system that enables better health, better care and lower costs. Trinity Health has 88 hospitals and hundreds of continuing care facilities, home care agencies and outpatient centers in 21 states and 119,000 employees.