Criteria for excision of suspected fibroadenomas of the breast

Hubbard, Jennifer L.; Cagle, Kathleen M.; Davis, James W.; Kaups, Krista L.; Kodama, Miya

doi:10.1016/j.amjsurg.2013.12.037

Cited by 25 publications

(19 citation statements)

References 11 publications

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“…In a series of 723 cases, Hubbard et al showed that those with a preoperative diagnosis of FA had this confirmed on excision in 94% (n = 681) cases. No cases of carcinoma were identified.…”

Section: Discussionmentioning

confidence: 97%

Is excision biopsy of fibroadenomas based solely on size criteria warranted?

et al. 2018

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Fibroadenomas (FA) are the most common benign tumor in the female breast. Most are managed conservatively provided there is clinical, radiologic, and pathologic concordance. However, surgical excision is typically recommended for cellular fibroepithelial lesions or those lesions with clinical, radiologic, or pathologic features concerning for phyllodes tumor (PT). Some studies have suggested surgical excision in all FA >30 mm to reduce core needle biopsy (CNB) sampling errors. The aim of our study was to evaluate, in the absence of any other concerning clinicopathologic features, whether surgical excision of FA was warranted based on size criteria alone. Cork University Hospital is a large academic center in Southern Ireland. Its breast cancer center provides both a screening and symptomatic service and diagnoses approximately 600 cancers per year. The breast histopathological data base was reviewed for all CNBs from January 1, 2010, to June 30, 2015, with a diagnosis of FA that went on to have excision at our institution. We excluded all cellular fibroepithelial lesions and those cases with co-existent lobular neoplasia, ductal carcinoma in situ, invasive carcinoma, atypical ductal hyperplasia, or lesions which would require excision in their own right. Cases in which the radiologic targeted mass was discordant with a diagnosis of FA were also excluded. Patient demographics and preoperative radiologic size and the radiologic target were recorded in each case. All radiology was reviewed by a breast radiologist prior to inclusion in the study, and there was histologic radiologic concordance with a diagnosis of FA in all cases. A total of 12,109 consecutive radiologically guided CNB were performed January 2010-June 2015; 3438 with a diagnosis of FA were identified of which 290 cases went on to have surgical excision. Of those 290 cases; 98.28% (n = 285) were confirmed as FA on excision. The remaining 1.72% (n = 5) had atypical features-FA with LCIS (n = 1), benign PT (n = 3), and invasive ductal carcinoma (n = 1). Our study suggests that, excision based solely on size is not warranted in clinical and radiologically concordant cases with a diagnosis of FA on CNB.

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“…In a series of 723 cases, Hubbard et al showed that those with a preoperative diagnosis of FA had this confirmed on excision in 94% (n = 681) cases. No cases of carcinoma were identified.…”

Section: Discussionmentioning

confidence: 97%

Is excision biopsy of fibroadenomas based solely on size criteria warranted?

et al. 2018

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“…PMBCs comprise less than 2% of all breast cancers [3], and they tend to have less involvement of axillary lymph nodes and a better prognosis than MMBCs [4].FAs, which contain both fibrous and epithelial components, are the most common benign neoplasm of the female breast [5]. About 40% of FAs have myxoid or edematous changes histopathologically [6].…”

mentioning

confidence: 99%

“…Regardless of these diagnostic difficulties, accurate preoperative diagnosis is crucial because the lesions require very different therapeutic approaches: The majority of FAs can be left untreated or followed and only a minority need enucleation [5], whereas PMBCs require surgical excision, most often with breast-conserving therapy and sentinel lymph node biopsy [9].…”

mentioning

confidence: 99%

Differentiation between Pure Mucinous Breast Carcinomas and Fibroadenomas with Strong High-Signal Intensity on T2-Weighted Images from Dynamic Contrast-Enhanced Magnetic Resonance Imaging

Luo

et al. 2017

Breast Care

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Objective: This study aimed to identify characteristics that can differentiate between pure mucinous breast carcinomas (PMBCs) and fibroadenomas (FAs) with strong high-signal intensity on T2-weighted images (T2-SHi) from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Methods: The DCE-MRI tumor characteristics were compared and analyzed between 35 PMBCs and 70 FAs with T2-SHi. Results: Multivariate analysis revealed that delayed enhancement pattern was the only significant independent predictor (p = 0.007). Conclusion: A delayed enhancement pattern is the most reliable characteristic for differentiating PMBCs from FAs with T2-SHi from DCE-MRI.

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“…The masses were in the right breast 1 Ultrasound reports showed some diversity in description of the mass in our series as well as in previously published series. 4,5 Among histological subtypes, cellular fibroadenomas have overlapping histopathological and radiological features with phyllodes tumors which are practically indistinguishable by ultrasound imaging. 5 There are absolutely no determinative features to distinguish between a fibroadenoma and a malignant phyllodes tumor by core | 1899 COMMENTARY biopsies.…”

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confidence: 99%

“…2 In a substantial number of children, the main surgical indication was anxiety and worry of the patient and the family despite all the reassurance about the low incidence of malignancy development in this age group as in the present series. 1,4,6,7 In one report, only one third of the children agreed to undergo a period of observation before surgery. 7 Most interactions with the patient lack clear information about the chances of recurrent or metachronous tumor development after excision because of limited data.…”

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confidence: 99%