From the Guidelines
Monitoring a breast fibroadenoma after biopsy confirmation should involve routine screening or a physical examination at 6 or 12 months, with or without ultrasound or mammogram, for 1 year to ensure that the lesion is stable, as recommended by the NCCN Panel 1. When a breast fibroadenoma is confirmed by biopsy, the primary concern is to ensure that the lesion does not exhibit any suspicious changes that could indicate malignancy.
- Key aspects of monitoring include:
- Regular clinical follow-up with physical examinations every 6-12 months
- Imaging surveillance, which may include ultrasound or mammogram, depending on the patient's age and breast tissue density
- Assessment of the lesion's size and characteristics over time
- According to the NCCN guidelines, if the lesion is stable, routine breast screening is recommended 1.
- However, if the lesion increases in size, surgical excision is recommended by the NCCN Panel 1.
- It is essential to educate patients to report any changes in the lesion between scheduled appointments, such as rapid growth, pain, or skin changes, as these could be indicative of a potential issue.
- The approach to monitoring breast fibroadenomas is based on the understanding that these lesions are benign and rarely transform into malignancy, with the risk being less than 0.1%, as supported by the NCCN guidelines 1.
From the Research
Monitoring Breast Fibroadenoma Confirmed by Biopsy
- The diagnosis of breast fibroadenoma is typically based on a combination of clinical examination, imaging, and non-surgical tissue biopsy, known as the triple test 2.
- The choice of imaging depends on the patient's age, with mammography and ultrasound used in older women, and ultrasound alone in younger women 2.
- Tissue biopsy, either fine-needle aspiration or core biopsy, is the most accurate means of establishing the diagnosis of fibroadenoma 2.
Management of Breast Fibroadenoma
- Symptomatic fibroadenomas were traditionally treated by surgical excision, but there is increasing evidence that a conservative approach is safe and acceptable, provided the result of an adequate triple test is both negative for cancer and consistent with a fibroadenoma 2.
- Percutaneous radiofrequency-assisted excision of fibroadenomas is a viable alternative to surgical removal, with minimal complications and high patient satisfaction 3.
- Ultrasound-guided vacuum-assisted biopsy (UGVAB) can serve as an efficient tool for the diagnosis and excision of breast fibroadenomas, with a high diagnosis compatibility rate and low complication rate 4.
Follow-up and Monitoring
- Patients with a confirmed diagnosis of fibroadenoma should be monitored for any changes in symptoms or clinical findings, and should be reassured and discharged unless there is overriding clinical concern 5.
- Imaging follow-up may be sufficient for patients with incomplete excision of fibroadenoma, unless the patient is uncomfortable with the remnant lump or there are concerns about malignancy 4.
- Emerging research into genomics and molecular aspects of fibroadenoma may lead to improved diagnostic accuracy and minimally invasive treatments, providing enhanced patient outcomes 6.