From the Guidelines
The most appropriate next step for this 25-year-old woman with a 3 cm breast lump confirmed as fibroadenoma by ultrasound who requests excision is option A: Excision after CNB (if >2cm, rapid growth, suspicious, patient request). This approach is based on the guidelines provided by the National Comprehensive Cancer Network 1, which suggest that fibroadenomas larger than 2 cm, those with rapid growth, suspicious features, or when the patient requests removal, should be considered for excision. Given the patient's specific request for removal due to her concerns about the lump and its relatively large size of 3 cm, proceeding with excision after confirming the diagnosis via core needle biopsy (CNB) is justified 1. The CNB is crucial as it provides a histological confirmation of the benign nature of the lesion before surgery, ensuring that the management plan is appropriate while addressing the patient's concerns 1. Key points to consider include:
- The size of the fibroadenoma is greater than 2 cm, which is a criterion for considering excision 1.
- The patient's request for removal due to anxiety or discomfort about the lump 1.
- The importance of confirming the benign diagnosis through CNB before proceeding with surgical excision to rule out other conditions like phyllodes tumor, which may present similarly but require different management 1. While other options like self-examination, mammogram, or CNB alone without planned excision might be considered in different scenarios, they do not adequately address the patient's request for removal and the specific characteristics of her fibroadenoma 1.
From the Research
Next Steps for a 25-year-old Lady with a 3 cm Fibroadenoma
- The patient has a confirmed fibroadenoma, which is a benign breast lump, and is worried about it, requesting excision 2.
- According to the study, surgical intervention is indicated by the presence of one or more of the following features: the presence of symptoms, a diameter greater than 2 cm, rapid growth rate, complex features, disease recurrence, or patient anxiety 2.
- In this case, the patient's fibroadenoma is 3 cm in diameter, which is greater than 2 cm, and the patient is anxious, making excision a reasonable option 2, 3.
- The study suggests that patients with age >35 years, immobile or poorly circumscribed mass, size >2.5 cm, or biopsy not definitive for fibroadenoma should undergo surgical excision 3.
- However, another study found that enlarging biopsy-proven fibroadenomas are not associated with malignancy, and surgical excision does not seem warranted unless there are associated atypia or suspected phyllodes tumor, or for symptomatic lesions or cosmetic reasons 4.
- Core needle biopsy can be used to differentiate phyllodes tumor from fibroadenoma, and a diagnosis of fibroadenoma on core needle biopsy can allow for observation and close follow-up or enucleation 5.
- Excision after core needle biopsy (CNB) is recommended if the fibroadenoma is greater than 2 cm, has rapid growth, is suspicious, or if the patient requests it, which is the case here 2, 3.