Fibroadenoma

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Fibroadenomas are the most common benign breast tumor in women under 35 years of age. Hormonal factors are thought to contribute to fibroadenoma growth, but the exact etiology is poorly understood. On examination, fibroadenomas are well-defined, mobile, typically solitary breast masses that are 1–2 cm in diameter on average. Giant fibroadenomas are much larger in size and can distort the shape of the breast. Patient history, physical examination, and age-appropriate imaging for a palpable breast mass are used to establish the diagnosis. Biopsy is not routinely required for diagnostic confirmation but may be indicated to rule out differential diagnoses (e.g., phyllodes tumor, breast cancer). Although most fibroadenomas are benign and have an excellent prognosis, complex adenomas are associated with an increased risk of breast cancer.

• The most common breast tumor in women < 35 years of age
• Peak incidence: 20–30 years

Epidemiological data refers to the US, unless otherwise specified.

• Idiopathic
• Possible hormonal etiology; (increased estrogen, e.g., during pregnancy may stimulate growth )

• Usually a well-defined, mobile mass
• Most commonly solitary
• Nontender
• Rubbery consistency
• Typically 1–2 cm in diameter
• Giant fibroadenomas are > 5 cm in size and may distort the shape of the breast. ^[3]

Follow age-appropriate diagnostic workup for a palpable breast mass. The findings specific to fibroadenoma are described here.

Imaging ^[3][4]

• Breast ultrasound: well-circumscribed oval or round hypoechoic solid mass with no posterior acoustic shadowing ^[2][4]
• Mammography ^[3]
  • Round mass with a well-defined border
  • May have popcorn-like calcifications
• Breast MRI : The appearance varies depending on whether hyalinization is present.

Biopsy

• Indications (not routinely indicated): imaging or clinical findings suspicious for malignancy or phyllodes tumor ^[2][3][5]
• Modalities: core needle biopsy, fine needle aspiration, or excisional biopsy ^[2][3][5]
• Findings: fibrous and glandular tissue ^[3]

Biopsy is not routinely required in patients with imaging findings consistent with a fibroadenoma and no clinical suspicion of malignancy or phyllodes tumor. ^[2][3][4]

Core needle biopsy or excisional biopsy is preferred if phyllodes tumor is suspected as FNAC cannot reliably distinguish between fibroadenomas and phyllodes tumors. ^[2][6]

• Phyllodes tumor
  • Tend to be larger in size
  • Often grow more rapidly than fibroadenomas
  • Usually occur in women ∼ 40 years of age
• Other benign breast lesions (e.g., breast cysts)
• Breast cancer

The clinical and imaging features of phyllodes tumors may closely resemble those of fibroadenomas, but the biological behaviors of these tumors are different. Borderline and malignant phyllodes tumors can metastasize hematogenously, and benign phyllodes tumors have a high risk of recurrence postexcision.

The differential diagnoses listed here are not exhaustive.

Management decisions should be made using shared decision-making.

Expectant management

• Indications ^[3][7]
  • Fibroadenomas < 2 cm in size ^[5]
  • Asymptomatic adolescent patients ^[7]
• Measures: routine clinical breast exams (CBE) and age-appropriate imaging for a palpable breast mass
  • Lesions diagnosed as fibroadenoma on imaging alone: Short-term (every 6 months for 2 years) follow-up with imaging is recommended. ^[2][3]
  • Biopsy-proven fibroadenomas: Longer surveillance intervals may be considered. ^[8]

Surgical excision

• Indications ^[3][5]
  • Large size (e.g., > 2 cm) or rapid growth
  • Suspected malignancy
  • Bothersome symptoms or cosmetic concerns

Minimally invasive procedures ^[3]

• Indications: an alternative to surgical excision for patients with biopsy-proven fibroadenomas
• Modalities
  • Thermal ablation : targeted cell destruction of the fibroadenoma
  • Vacuum-assisted percutaneous excision: removal of the fibroadenoma using a hollow bore needle under image guidance

• Generally good
• Most fibroadenomas are not associated with an increased risk of breast cancer.
• Complex fibroadenomas may be associated with an increased risk of breast cancer.