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

Abstract

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.

A retrospective evaluation of pediatric breast fibroadenomas with mid‐term follow‐up results

“…Yet, conservative follow‐up for pediatric breast masses is recommended by most authors mainly because the incidence of malignant breast tumors is very low in children and also a malignant change in a fibroadenoma is rare 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 .…”

“…5 There are absolutely no determinative features to distinguish between a fibroadenoma and a malignant phyllodes tumor by core | 1899 COMMENTARY biopsies. 2,6 Juvenile fibroadenomas are known to occur more commonly in younger children and have a tendency for rapid growth. 2,3 The child with juvenile fibroadenoma was the youngest patient in our series.…”

“…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.…”

“…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 biopsies 2,6 . Juvenile fibroadenomas are known to occur more commonly in younger children and have a tendency for rapid growth 2,3 .…”

Invasive Lobular Carcinoma within a Fibroadenoma: A Case Report and Review of the Literature

“…Neville G et al [18] suggested that excision based solely on size is not warranted in clinically and radiologically concordant cases with a diagnosis of FAD on CNB. Their study included a total of 12,109 consecutive radiologically guided CNB that were performed in a period of time of 5 years; 3438 with a diagnosis of FAD were identified of which 290 cases went on to have surgical excision.…”