Ultrasound Can Accurately Diagnose Fibroadenomas in Women Less Than 35 Years

Abstract

proved so has the quality of US images. Therefore, the role of ultrasound has expanded beyond characterizing solid from cystic masses, but now also has a role in distinguishing between malignant and benign breast lumps such as fibroadenomas. Many studies have shown that FNA or core biopsy are not required to confirm the diagnosis of fibroadenomas in young women [1,2] providing strict criteria are used; no known risk factors for breast malignancy; mass not rapidly enlarging; smooth discrete mobile mass on clinical examination, or lesion impalpable; well-defined homogeneously isoechoic or mildly hypoechoic solid mass; less than 3 cm in greatest dimension; ovoid shape, aligned parallel to the skin surface; smooth or gently lobulated contour (two or three lobulations only; no microlobulation); thin echogenic pseudocapsule; no calcification; no acoustic shadowing [1][2][3]. We propose that the age can be increased to 35 years providing the above strict criteria are used, and there is no clinical suspicion of a malignant lesion. The purpose of this study was to review the need to biopsy fibroadenomas in the 25 to 35-year age group. MethodsRecords of women presenting to East Lancashire NHS Trust Breast Unit between 2013 and 2015 were obtained. Only patients between 25 and 35 years at the age of presentation, with clinical benign (P2-benign) breast lump and an USS diagnosis of fibroadenoma (U2-benign) were included in the study. All ultrasounds were performed by Breast Radiologists or Advanced Mammography Practitioners using an Aplio 500 ultrasound system (Toshiba), linear-array transducer with frequency range of 7 to 18 MHz Corresponding Fine Needle Aspiration (FNA) cytology was noted and if there were Abstract Introduction: Best practice guidelines suggest that patients < 25 years with ultrasound diagnosis of fibroadenoma, biopsy can be avoided if certain radiological criteria are satisfied. There is a cohort of patients < 35 years with ultrasound features suggestive of fibroadenoma who are being exposed to unnecessary biopsies. The aim of this study is to determine how many patients with ultrasound features of fibroadenoma have had normal histology and therefore could potentially avoid a biopsy.

Palpable breast lumps: An age-based approach to evaluation and diagnosis

“…Features on ultrasound that are consistent with a fibroadenoma include the following: (1) a well-defined homogeneously isoechoic or mildly hypoechoic solid lump with a maximum dimension of less than 30 mm; (2) an ovoid shape, lying parallel to the surface of the skin, with a smooth or gently lobulated contour; (3) a thin, echogenic pseudocapsule; and (4) lack of calcification and acoustic shadowing. 8 Ultrasound is not hampered by breast density and is accurate for distinguishing between benign and malignant breast lesions, which are its main advantages compared with mammograms. 9 , 10 Fibroadenomas are the most common lumps in young women, and ultrasound has been shown to have a sensitivity of 81.6% and specificity of 94.7% for making the diagnosis.…”