Download - Management of Fibroadenomas
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Benign Breast DiseaseFibroadenomas
ASBS Annual MeetingPhoenix 2012
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Disclosure
Consultant: IceCure Medical
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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
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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
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Pathology
• May have associated benign or ADH – no increased risk of CA
• Malignancy uncommon
• Prognosis depends on overall extent of disease
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Imaging - Ultrasound
• Well defined border• Hypoechoic• Wider-than-Tall or
round • +/- Edge Shadowing
and Posterior Enhancement
• When in doubt - BIOPSY
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Imaging - Mammogram
• Well defined, smooth or lobulated margin
• May have coarse calcifications
• Often borders are obscured due to dense breast tissue
• MRI – variable enhancement
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Diagnosis
Surgical excision
Fine Needle Aspiration
Ultrasound-Guided Core Biopsy
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Treatment Options
Observation – every 3-12 months with clinical exam, ultrasound, +/- biopsy or FNA
Surgical excision – Recurrence vs. new lesions / field effect
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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
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Treatment OptionsLaser Ablation
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Cryoablation
Animation images courtesy Sanarus Medical Technology
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Cryoablation
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Consensus Statement
American Society of Breast Surgeons Consensus Statement, “Management of Fibroadenomas of the Breast,” www.breastsurgeons.org
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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.