management of fibroadenomas

Benign Breast DiseaseFibroadenomas

ASBS Annual MeetingPhoenix 2012

Disclosure

Consultant: IceCure Medical

Fibroadenomas

• 25% of normal breasts at autopsy• Peak age 20-24• Multiple in 7-15%

• Most growth arrested by 2-3cm; may reach >10cm• Spontaneous infarction – pregnancy/lactation• Reports of regression

• Unopposed estrogen influence, OCP use prior to age 20

• RR Cancer 1.6-2.1• RR Cancer 3.1 with Complex FA

Pathology• ANDI – Aberration of Normal

Development and Involution, arise in TDLU

• Benign biphasic lesions – epithelial and stromal component

• Intracanalicular / Pericanalicular

• Usually well defined border, varying degree of stromal cellularity

• Phyllodes – leaf-like projections, dense hypercellular / malignant stroma

Pathology

• May have associated benign or ADH – no increased risk of CA

• Malignancy uncommon

• Prognosis depends on overall extent of disease

Imaging - Ultrasound

• Well defined border• Hypoechoic• Wider-than-Tall or

round • +/- Edge Shadowing

and Posterior Enhancement

• When in doubt - BIOPSY

Imaging - Mammogram

• Well defined, smooth or lobulated margin

• May have coarse calcifications

• Often borders are obscured due to dense breast tissue

• MRI – variable enhancement

Diagnosis

Surgical excision

Fine Needle Aspiration

Ultrasound-Guided Core Biopsy

Treatment Options

Observation – every 3-12 months with clinical exam, ultrasound, +/- biopsy or FNA

Surgical excision – Recurrence vs. new lesions / field effect

Treatment OptionsVacuum Assisted Excision

Immediate Results: Complete removal of imaged lesion– 99% (74/75) of 8-gauge biopsies– 96% (47/49) of 11-gauge

biopsies

6 Month Follow Up: Small percentage palpable2% (1/61) of 8-gauge biopsy sites3% (1/38) of 11-gauge biopsy sites

Removal of imaged lesion70% (43/61) of 8-gauge biopsies79% (30/38) of 11-gauge biopsies

Treatment OptionsLaser Ablation

Cryoablation

Animation images courtesy Sanarus Medical Technology

Cryoablation

Consensus Statement

American Society of Breast Surgeons Consensus Statement, “Management of Fibroadenomas of the Breast,” www.breastsurgeons.org

References• Tavassoli Pathology of the Breast Appleton and Lange 1999• Schnitt, SJ and Connolly, JL Pathology of Benign Breast Disorders. In: Harris, Lippman,

Morrow and Osborne Diseases of the Breast Lippincott, Williams and Wilkins 2004• Whitworth, P. Cryoablation of Fibroadenomas. In: Kuerer’s Breast Surgical McGraw-Hill

2010• Kaufman CS, Littrup PJ, Freeman-Gibb LA, et al. Office-based Cryoablation of Breast

Fibroadenomas With Long-term Follow-up. Breast J. 2005; 11:344-350• Dixon J, Dobie V, Lamb J, Walsh J, Chetty U. Assessment of the Acceptability of

Conservative Management of Fibroadenoma of the Breast. Br J Surg. 1996;83:264-265• Fine R, Whitworth P, Kim JA, et al. Low-risk Palpable Breast Masses Removed Using a

Vacuum-assisted Hand-held Device. Am J Surg. 2003;186:362-367• Dennis MA, Parker SH, Klaus AJ, et al. Breast Biopsy Avoidance: The Value of Normal

Mammograms and Normal Sonograms in the Setting of a Palpable Lump. Radiology. 2001;219:186-191

• Dowlatshahi K, Wadhwani S, Alvarado R, Valadez C, Dieschbourg J. Interstitial Laser Therapy of Breast Fibroadenomas With 6 and 8 year Follow Up. Breast J. 2010: 16:73-76

• American Society of Breast Surgeons Consensus Statement “Management of Fibroadenomas of the Breast” www.BreastSurgeons.org

• James JJ, Robin A, Wilson M, Evans J. Women's Imaging: The Breast. In: Adam A, Dixon AK, Grainger RG, Allison DJ, eds. Grainger & Allison's Diagnostic Radiology. 5th ed. Philadelphia, PA: Elsevier: 2008:1173-1200.