From the Guidelines
The workup for fibroadenoma typically begins with a clinical breast examination followed by imaging studies, with ultrasound as the preferred initial modality for women under 30 and mammography plus ultrasound recommended for women over 30. The initial evaluation should prioritize the patient's age and clinical presentation. For women under 30, ultrasound is the preferred initial imaging modality due to the low incidence of breast cancer and the increased radiation risk associated with mammography 1. In contrast, women over 30 should undergo mammography plus ultrasound, as the incidence of breast cancer increases with age and mammography is more sensitive in this age group 1.
Imaging Modalities
- Ultrasound: preferred initial modality for women under 30, can characterize lesions and guide biopsies
- Mammography: recommended for women over 30, can detect lesions and guide biopsies
- Digital Breast Tomosynthesis (DBT): can be used in addition to mammography, improves lesion characterization and detection
Biopsy and Management
If imaging suggests a fibroadenoma, a core needle biopsy should be performed to confirm the diagnosis. For small fibroadenomas (less than 2-3 cm) with benign features on imaging and biopsy, observation with follow-up imaging at 6-12 month intervals is appropriate. However, surgical excision is recommended for fibroadenomas that are large (>2-3 cm), rapidly growing, symptomatic, or have atypical features on imaging or biopsy 1. Vacuum-assisted excision is an alternative minimally invasive option for complete removal.
Special Considerations
Fibroadenomas require workup because they must be distinguished from other breast masses, including malignancies. Complex fibroadenomas with cystic changes, sclerosing adenosis, epithelial calcifications, or papillary apocrine changes carry a slightly higher risk of future breast cancer and warrant closer surveillance 1. The management of fibroadenomas should prioritize the patient's age, clinical presentation, and imaging features to minimize morbidity and mortality while maintaining quality of life.
From the Research
Diagnosis of Fibroadenoma
The diagnosis of fibroadenoma is based on a combination of:
- Clinical examination
- Imaging, which includes mammography and ultrasound 2
- Non-surgical tissue biopsy, also known as the triple test 2
Imaging Techniques
The choice of imaging technique depends on the age of the patient:
- In older women, mammography is used in combination with ultrasound 2
- In younger women, ultrasound alone is used 2, 3
- Doppler ultrasound and mammography or Doppler ultrasound alone can also be used to confirm the clinical suspicion of fibroadenoma 4
Tissue Biopsy
Tissue biopsy is the most accurate means of establishing the diagnosis of fibroadenoma:
- Fine-needle aspiration or core biopsy can be used to obtain a tissue diagnosis 2
- Ultrasound-guided vacuum-assisted biopsy (UGVAB) can also be used for the diagnosis and excision of breast fibroadenomas 4
Management of Fibroadenoma
The management of fibroadenoma includes:
- Surgical excision, which is a traditional treatment option 2, 3, 5
- Conservative management, which is a safe and acceptable option provided the result of an adequate triple test is both negative for cancer and consistent with a fibroadenoma 2
- Minimally invasive techniques, such as UGVAB, which can be used for the diagnosis and excision of breast fibroadenomas 4
- Imaging follow-up, which is important for monitoring fibroadenomas, especially in cases with multiple lesions 6
Special Considerations
In adolescent women, fibroadenomas are the most common breast masses: