From the Guidelines
Fibroadenoma is a common benign breast tumor that typically affects women in their teens to early thirties and usually doesn't require treatment unless it causes discomfort or anxiety, with most cases being safely monitored with regular follow-up exams every 6-12 months 1.
Diagnosis and Evaluation
The diagnosis of fibroadenoma typically involves a clinical breast exam, ultrasound, and possibly a biopsy to confirm the diagnosis. Ultrasound findings of a solid mass with benign features, such as oval or round shape, abrupt well-defined margin, homogeneous echogenicity, and orientation parallel to the chest wall with no posterior acoustic shadowing, are highly suggestive of a fibroadenoma 1.
Management
Most fibroadenomas can be safely monitored with regular follow-up exams every 6-12 months to ensure they don't change in size or character. Surgical removal (lumpectomy) may be recommended if the fibroadenoma is large (over 2-3 cm), growing rapidly, causing symptoms, or if there's uncertainty about the diagnosis 1.
Key Considerations
- Fibroadenomas develop from the lobules and stroma (connective tissue) of the breast and are stimulated by estrogen, which explains why they often appear during reproductive years and may grow during pregnancy or with hormonal medication use.
- They typically feel firm, smooth, and mobile ("breast mouse") when touched and can be single or multiple.
- While fibroadenomas don't increase breast cancer risk for most women, regular breast self-exams and appropriate screening are still important for overall breast health.
- In cases where the diagnosis is uncertain, or the fibroadenoma is large or rapidly growing, excisional biopsy may be necessary to rule out phyllodes tumor, a rare tumor that can be difficult to distinguish from fibroadenoma based on imaging alone 1.
From the Research
Definition and Prevalence of Fibroadenoma
- Fibroadenomas comprise between 30% and 50% of all breast biopsies, as reported in a study published in the Journal of the American College of Surgeons 2
- They are the most common benign tumor in the female breast, according to a study in The Breast Journal 3
Treatment Options for Fibroadenoma
- Cryoablation is a safe and effective nonsurgical treatment for breast fibroadenomas, with a 12-month follow-up showing an 89% median tumor volume reduction and 75% of fibroadenomas becoming nonpalpable 2
- Vacuum-assisted excision biopsy is also a viable option, with high patient satisfaction and efficacy, as reported in Clinical Radiology 4
- Surgical excision is typically recommended for cellular fibroepithelial lesions or those with clinical, radiologic, or pathologic features concerning for phyllodes tumor (PT) 3
Post-Treatment Follow-up and Imaging
- Ultrasound imaging follow-up of the ablated tumor is recommended at 6-month intervals for 2 years after cryoablation therapy 5
- Knowledge of typical ultrasound changes over time is imperative to prevent unnecessary rebiopsy or excision in patients who have undergone cryoablation 5