Abstract
ContextDiscriminating adipose and glandular tissue is challenging when clinically assessing breast development. Ultrasound facilitates staging of pubertal breast maturation (US B), but has not been systematically compared to Tanner breast (Tanner B) staging, and no normative data have been reported.ObjectiveTo present normative references for US B along with references for Tanner B, pubic hair (PH), and menarche.Design, Setting, and ParticipantsA cross-sectional sample of 703 healthy girls aged 6 to 16 years were examined.Main Outcome MeasuresBreast development was determined with US B and Tanner B staging. Tanner PH and menarcheal status were recorded. The age distributions of entry in US B, Tanner B, and PH stages and menarche were estimated with generalized linear and generalized additive models with a probit link. Method agreement was tested with weighted Cohen’s kappa.ResultsThe median (±2SD) ages for thelarche, US B2 and Tanner B2, were 10.2 (7.7, 12.8) and 10.4 (8.0, 12.7) years. The median (±2SD) ages at Tanner PH2 and menarche were 10.9 (8.5, 13.3) and 12.7 (11.0, 16.2) years. Cohen’s kappa of agreement (95% confidence interval) between US B and Tanner B was 0.87 (0.85–0.88). When the methods disagreed, US B was usually more advanced.ConclusionThelarche occurred at a slightly younger age when assessed with ultrasound compared to clinical Tanner staging, although the 2 methods had a very good agreement when determining pubertal breast maturation. A significant decrease of 2.8 months in age at menarche was observed during the past decade in Norwegian girls.
Highlights
Breast development in girls is usually defined clinically by the five-stage scale as described by Marshall and Tanner in 1969 [1,2]
Thelarche occurred at a slightly younger age when assessed with ultrasound compared to clinical Tanner staging, the two methods had a very good agreement when determining pubertal breast maturation
A significant decrease of 2.8 months in age at menarche was observed during the past decade in Norwegian girls
Summary
Breast development in girls is usually defined clinically by the five-stage scale as described by Marshall and Tanner in 1969 [1,2]. The Tanner breast (B) scale ranges from B1 (prepubertal) to B5 (mature), in which stage B2 marks the first appearance of glandular breast tissue (thelarche) and the start of central puberty. We, and others, have been able to identify distinctive breast developmental stages based on changes in the appearance and relative amount of glandular, adipose and fibrous tissues [3,4,5]. Despite being a promising method, ultrasound staging of the breast has not yet been systematically compared with clinical Tanner B staging in a large developmentally diverse sample, and no normative references have yet been published. A worldwide secular trend towards younger ages at thelarche according to race/ethnicity and geography was shown in a recent systematic review [13]
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