E1064. Overutilization of Emergent Pediatric Breast Ultrasounds
  1. Deanna Kitchen; UT Southwestern Medical Center
  2. Miranda Gleason; Baylor Scott & White
  3. Mary Dinh; Pennsylvania State University
  4. Nikhil Godiyal; The University of Texas at Dallas
  5. Cory Pfeifer; UT Southwestern Medical Center
Breast ultrasounds are commonly utilized in the diagnostic approach to breast masses in the adult population (1). However, breast cancer is exceedingly rare in children (2,3), and non-urgent etiologies tend to predominate. In a large cohort of pediatric patients with palpable breast lumps, benign etiologies including gynecomastia, lymph nodes, fibroadenoma, galactocele, and infection predominated with no malignant cases (4). Considering the exceedingly rare circumstance that a child has breast cancer, how breast ultrasound is utilized in a pediatric clinical picture should differ, especially when ordered in an emergency setting. If the breast mass is not concerning for infection, there is limited utility of performing breast ultrasound in the emergency department. However, because of availability, pediatric emergency medicine providers often opt to order breast ultrasounds for breast-related complaints regardless of whether the indication is emergent.

Materials and Methods:
All breast ultrasounds ordered in the emergency departments of two large children's hospitals over eight years were reviewed. The reason for exam was recorded and compared to a similar cohort of breast ultrasounds ordered in the outpatient setting.

Infection-related indications for pediatric breast ultrasound were ten times as common in the emergency department compared to outpatient pediatric breast ultrasounds. However, 67% of emergent ultrasounds were ordered for non-acute conditions. Fibroadenomas were suggested in 102 out of 682 female pediatric breast ultrasounds ordered in the emergency department. The most common indication for emergent breast ultrasound in female children was assessment of a lump or bump without evidence of infection. The most common assigned diagnosis in male children undergoing ultrasound in the emergency department was gynecomastia.

Pediatric emergency department providers in children's hospitals are likely to order breast ultrasound for non-acute conditions if pediatric radiologists are willing to interpret them. Given the cost associated with emergency department radiology utilization, emergency providers may be better served to refer children with non-emergent breast-related conditions to outpatient centers. In addition to being more cost effective by limiting emergency imaging and allowing for faster discharges, it will also allow for more thorough evaluation with BI-RADS, and allow for biopsy in the rare circumstance it is clinically necessary. When indicated on reason for exam, benign etiologies may be screened for improved utilization of pediatric emergency radiology services.