ESPE Abstracts

Context: Assessment of breast development by physical examination(PE) can be difficult especially in overweight girls and in early stages. We aimed to study ultrasonography(USG) on evaluation of breast tissue in girls with breast development< 8 years of age.

Patients and Methods: In this prospective study, 125 girls (age 7.1±1.5 years) with early breast development were evaluated by breast USG for ultrasonographic breast staging (Garcia), breast volume and shear wave elastography, in addition to routine clinical and hormonal evaluation.

Results: PE revealed, glandular breast enlargement in 100 and lipomastia in 25. Breast USG in the former group confirmed the presence of glandular breast development in 92:(USG+), but in 8:(USG-). All Tanner stage III and above breasts on PE were also reported to have glandular breast tissue on USG, whereas all (USG-) subjects had Tanner stage II breasts on PE. Comparison of the 8 USG(-) with 92 USG(+) patients demonstrated lower Tanner (2±0 vs 2,5±0,5, p:0.014) and Garcia staging (1 vs 3 P<0.01), BA/CA (0.9±02 vs 1,1±0,1, P<0.05), basal LH (0,28±0,12vs0,69±1,2, p:0.09), breast volume (0,45±0,28 vs 8,3±8cc, P<0.001), uterine length (26,5±6,1 vs 33,1±5,9mm, P<0.05), uterine volume (1,0±0,4vs2,6±1,6cc, P<0.01) and ovarian volume (2,1±0,72vs4,2±2,4cc, p:0.02). Breast USG in 25 lipomastia patients demonstrated no breast tissue in 19:(USG-), but Garcia stage >II in 6:(USG+). There were no differences in the features of CPP between two groups except slightly elevated breast volume in USG(+)(2,04±1,9 vs 0,39±0,2cc, p:0.02). After clinical evaluation and follow-up (19.8±4.2 month), 46/125 subjects were diagnosed with progressive CPP and started on treatment. Garcia stage (3,2±0,7 vs 2,3±0,9), total breast volume(11,6±10,9 vs 3,9±4,1), and elastography(17,8±3,4 vs 14,9±4,2) were significantly higher in the progressive group compared to nonprogressive group (P<0.01 for all). Receiver operative characteristics and sensitivity and specifity of significant variables for diagnosis of CPP were calculated. Total breast volume> 6.2cc had sensitivity of 78% and specifity of 71%, P<0.0001. Elastography>16kPa had sensitivity of 68% and specifity of 65%, P<0.001. These were 73% and 88% for peak LH>5.4 mIU/l and 73% and 71% for uterine volume>2.1cc, respectively.

Conclusion: Breast USG is a useful predictive tool for diagnosis of PP in girls<8yr with Tanner stage II breasts. Higher USG Garcia scores, breast volume and elastography increases the likelihood of eventual diagnosis of PP.