From the Guidelines
Fibroadenoma of the breast is a benign (non-cancerous) tumor. These are the most common benign breast tumors, typically affecting women in their teens and twenties, though they can occur at any age. Fibroadenomas usually present as firm, smooth, mobile lumps in the breast that are painless and have well-defined borders. They typically range from 1-5 cm in size. Most fibroadenomas don't require treatment unless they're large, growing, or causing discomfort. Management options include observation with regular follow-up, ultrasound monitoring, or surgical removal (excisional biopsy) if the lesion is concerning.
Key Characteristics of Fibroadenomas
- Firm, smooth, mobile lumps
- Painless
- Well-defined borders
- Typically 1-5 cm in size
- Develop from the terminal duct lobular unit of the breast
- Consist of both glandular and stromal (connective tissue) components According to the American College of Radiology, the addition of US will often yield a definitively benign result, such as a simple cyst or a solid mass with benign features, including oval or round shape, abrupt well-defined margin, homogeneous echogenicity, and orientation parallel to the chest wall with no posterior acoustic shadowing 1. The vast majority of these lesions represent benign fibroadenomas.
Management Options
- Observation with regular follow-up
- Ultrasound monitoring
- Surgical removal (excisional biopsy) if the lesion is concerning It's essential to have any breast lump evaluated by a healthcare provider for proper diagnosis and management, as some lesions may require further investigation or treatment. While fibroadenomas are not precancerous and do not increase breast cancer risk for most women, it's crucial to monitor any changes or concerns. As noted in the guidelines, short-interval follow-up is a reasonable alternative to biopsy for palpable solid masses with benign features identified by US if the clinical examination also suggests a benign etiology 1.
From the Research
Definition and Characteristics of Fibroadenoma
- Fibroadenomas of the breast are common benign lesions that predominantly affect young women 2.
- They typically present as palpable breast lumps, often with no associated nipple discharge, and their diagnosis relies on a combination of clinical examination, breast imaging, and pathological confirmation 2.
- Fibroadenomas are not at significant increased risk of developing breast cancer 3.
Diagnosis and Treatment
- Diagnosis is based on the combination of clinical examination, imaging, and non-surgical tissue biopsy (the triple test) 3.
- The choice of imaging is mammography, combined with ultrasound in older women, and ultrasound alone in younger women 3.
- Tissue biopsy, by either fine-needle aspiration or core biopsy, is the most accurate means of establishing the diagnosis 3.
- Surgical interventions, including excisional biopsy and lumpectomy, offer symptom relief and favorable long-term outcomes 2.
- Minimally invasive techniques, such as ultrasound-guided vacuum-assisted biopsy (UGVAB) and cryoablation, are also effective options for the diagnosis and treatment of breast fibroadenomas 4, 5.
Variants of Fibroadenomas
- Fibroadenomas have different histopathologic characteristics and components, and variants include juvenile, giant, complex, myxoid, cellular, and hyalinised fibroadenomas 6.
- These variants have different clinical behaviors, potential for malignant transformation, and treatment strategies 6.
- Imaging findings of simple fibroadenomas and other variants of fibroadenomas are important for diagnosis and treatment 6.