management of fibroadenomas
TRANSCRIPT
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.