What is the management for a 19-year-old female with a diagnosed fibroadenoma (benign breast tumor) of the breast, presenting as a 3 x 2 cm rounded, firm, mobile mass on ultrasound (US) and confirmed by core needle biopsy (CNB)?

Management of Fibroadenoma in a 19-Year-Old Female

The appropriate management for a 19-year-old female with a 3 x 2 cm fibroadenoma confirmed by ultrasound and core needle biopsy is follow-up rather than immediate excision (option D). 1

Rationale for Follow-up Management

Age-Appropriate Imaging and Diagnosis

• For women under 30 years old, ultrasound is the preferred initial imaging modality for evaluating breast masses 1
• The patient has already received appropriate diagnostic workup with:
  • Ultrasound (appropriate first-line imaging for her age)
  • Core needle biopsy (CNB) confirming fibroadenoma diagnosis

Management Based on Pathology

• For benign pathology with imaging-pathology concordance (as in this case):
  • Follow-up with ultrasound every 6-12 months for 1-2 years is recommended before returning to routine screening 1
  • Conservative management is considered safe and acceptable for fibroadenomas in patients under 40 years 2

Why Excision is Not Indicated

• Surgical excision is typically indicated only when one or more of the following features are present 3:

  • Symptoms causing significant discomfort
  • Rapid growth rate
  • Complex features on imaging or pathology
  • Disease recurrence
  • Patient anxiety that cannot be alleviated with reassurance

• While this fibroadenoma is 3 x 2 cm (slightly larger than 2 cm), size alone is not sufficient reason for excision 4

  • A 2018 study found that excision based solely on size criteria is not warranted when there is clinical and radiological concordance with the diagnosis of fibroadenoma on CNB 4

Why Other Options Are Not Appropriate

• Mammography (option B): Not indicated as the initial imaging modality for women under 30 years 1

  • The patient has already had appropriate imaging with ultrasound
  • Mammography offers no additional benefit in this confirmed case

• Tamoxifen (option C): Not indicated for the management of fibroadenomas

  • No evidence supports tamoxifen use for fibroadenomas in current guidelines

Follow-up Protocol

1. Clinical examination and ultrasound every 6-12 months for 1-2 years 1
2. Patient education about normal fibroadenoma behavior:
   • Some fibroadenomas may increase in size
   • Some may decrease in size or resolve completely
   • Most show no significant change 2

When to Consider Surgical Intervention

Surgical excision should be considered if during follow-up:

• The fibroadenoma shows significant growth 5
• The patient develops symptoms related to the mass
• Imaging features change and become suspicious
• The patient strongly desires removal despite reassurance

Important Caveats

• The risk of malignancy in or adjacent to a core-biopsied fibroadenoma is extremely low (0.58%) 5
• The risk of malignancy in a growing fibroadenoma is even rarer 5
• Some enlarging fibroadenomas may rarely be reclassified as benign phyllodes tumors on excision, but this does not significantly change management in most cases 5

Conservative management with regular follow-up is the most appropriate approach for this young patient with a confirmed benign fibroadenoma.