From the Guidelines
Breast fibroadenomas typically don't require treatment unless they cause symptoms or significant concern, and watchful waiting with regular follow-up examinations is the standard approach. When considering treatment options, it's essential to prioritize morbidity, mortality, and quality of life as the primary outcomes. According to the provided evidence 1, the treatment approach for breast fibroadenomas is primarily observational, with excisional biopsy considered for cases with a high clinical suspicion of phyllodes tumor, such as palpable mass, rapid growth, large size (> 2 cm), or imaging suggestive of fibroadenoma except for size and/or history of growth. Key points to consider in the management of breast fibroadenomas include:
- Clinical suspicion of phyllodes tumor: palpable mass, rapid growth, large size (> 2 cm), or imaging suggestive of fibroadenoma except for size and/or history of growth
- History and physical exam, including ultrasound and mammogram for women aged 30 years
- Excisional biopsy for cases with a high clinical suspicion of phyllodes tumor or indeterminate findings
- Wide excision with the intention of obtaining surgical margins 1 cm for cases requiring surgical intervention It's crucial to note that excisional biopsy is recommended for cases with a high clinical suspicion of phyllodes tumor or indeterminate findings, as fine-needle aspiration (FNA) and core needle biopsy may not distinguish fibroadenoma from phyllodes tumor in most cases 1. In terms of specific treatment options, surgical excision (lumpectomy) is a viable option for larger or growing fibroadenomas, which involves removing the lump under local anesthesia through a small incision. Minimally invasive alternatives, such as vacuum-assisted excision, cryoablation, or focused ultrasound ablation, can also be considered, but the evidence for these approaches is limited 1. Ultimately, the treatment approach for breast fibroadenomas should prioritize the individual patient's needs and concerns, with a focus on minimizing morbidity, mortality, and optimizing quality of life.
From the Research
Treatment Options for Breast Fibroadenomas
- Cryoablation is a minimally invasive office-based procedure that has been shown to be a safe and effective treatment for breast fibroadenomas 2, 3, 4, 5.
- The procedure involves the use of a cryoprobe to freeze the tumor, resulting in its shrinkage or elimination 2.
- Cryoablation has been shown to have excellent patient satisfaction, minimal scarring, and outstanding cosmesis 2, 3, 4.
- The treatment response is inversely related to the tumor size, with lesions less than 2 cm showing an optimal response 5.
Comparison to Other Treatment Options
- Surgical excision is a traditional treatment option for breast fibroadenomas, but it can result in scarring and patient dissatisfaction 2, 3.
- Cryoablation offers a preferred option for those patients desiring definitive therapy for their fibroadenomas without surgical intervention 3, 4.
- Conservative management may be a safe option for clinically and cytologically benign breast lumps in women under 25 years, but patient acceptance is low 6.