What is the initial management for a patient with fibroadenoma of the breast?

From the Guidelines

The initial management for a patient with fibroadenoma of the breast typically involves observation and regular follow-up if the diagnosis is confirmed and the lesion is small (less than 3 cm) 1. For a definitive diagnosis, a core needle biopsy or fine needle aspiration should be performed, especially if there are any concerning features on imaging. Ultrasound is the preferred imaging modality for women under 30, while mammography with ultrasound is recommended for women over 30. Most fibroadenomas do not require surgical excision as they are benign breast tumors that often remain stable or may even regress spontaneously, particularly in younger women. However, surgical excision should be considered if the fibroadenoma is large (greater than 3-4 cm), rapidly growing, causing symptoms such as pain or discomfort, or if the patient prefers removal for peace of mind. Some key points to consider in the management of fibroadenoma include:

• The use of imaging follow-up for probably benign features on mammography and US, with image-guided FNAB considered if there are mitigating reasons to establish a definitive diagnosis more immediately 1.
• The recommendation for routine breast screening if the lesion is stable, and the consideration of risk-reduction therapy according to the NCCN Breast Cancer Risk Reduction Guidelines for patients with atypical hyperplasia or LCIS 1.
• The importance of patient education on breast self-examination and encouraging patients to report any changes in the size or characteristics of the fibroadenoma. The rationale for this conservative approach is that fibroadenomas pose minimal risk for malignant transformation, and unnecessary surgery can be avoided while still ensuring patient safety through appropriate monitoring 1.

From the Research

Initial Management of Fibroadenoma of the Breast

The initial management for a patient with fibroadenoma of the breast typically involves a combination of clinical examination, imaging, and non-surgical tissue biopsy, also known as the triple test 2. This approach is recommended because a clinical diagnosis of fibroadenoma alone is unreliable and does not exclude malignancy, even in younger women 2.

Diagnostic Tools

• Clinical examination: to assess the characteristics of the breast lump, such as its size, shape, and mobility 3, 2
• Imaging: mammography and ultrasound are commonly used to evaluate the breast lump, with ultrasound being the preferred method for younger women 2, 4
• Non-surgical tissue biopsy: fine-needle aspiration or core biopsy can be used to obtain a tissue sample for pathological examination 2, 5

Treatment Options

• Conservative management: this approach is safe and acceptable for patients with fibroadenoma, provided the result of the triple test is negative for cancer and consistent with a fibroadenoma 2, 5
• Surgical intervention: indicated for patients with symptoms, a diameter greater than 2 cm, rapid growth rate, complex features, disease recurrence, or patient anxiety 3, 6

Monitoring and Follow-up

• Patients with small fibroadenomas (less than 4 cm in diameter) can be monitored with regular follow-up examinations and imaging studies 5
• Acceptable growth rates for fibroadenomas have been established, with a 95th percentile for percentage change in volume per month of approximately 16% for patients younger than 50 years and 13% for patients 50 years or older 4