Biopsy proven fibroadenomas- how frequent is pathologies other than fibroadenomas post-excision?

 
 
 
  • Abstract
  • Keywords
  • References
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  • Abstract


    Introduction: Breast fibroadenoma (FA) is a common benign tumour diagnosed usually through ‘Triple Assessment’. FA that is large, symptomatic or exhibit interval growth is recommended for excision. Some patients question the need for excision if preoperative assessment concluded FA while others want to be absolutely sure that the ‘FA’ that is not excised and managed conservatively is absolutely a FA. The aim of the present study is to ascertain the magnitude of unexpected post-excision pathology when a biopsy proven FA is excised according to the current UK guideline.

    Materials and Method: Retrospectively analysis of patients who underwent surgery for FA excision over a 3 year period. Data on patient demographics, ultrasound findings and size at diagnosis, any interval change in size, indication for excision were collected and pathology pre- and post-excision compared.

    Result: Of the 276 FA excised in 258 patients in 3years, a preoperative diagnosis of FA was confirmed in 251 cases while 25 breast lumps were excised based on the benign features on examination and imaging. The post excision histopathology confirmed the preoperative diagnosis of FA in 264 (95.7%), phyllodes in 8(3%) and 4 (1.3%) other pathologies.

    Conclusion: 4.3% of FA excised in our specialist unit after Triple Assessment returns pathology other than FA post-excision, mostly benign phyllodes. FAs should be managed conservatively after triple assessment but surgery should be offered if there is still any doubt as there is no absolute guarantee that the presumed FA is actually a FA. For medicolegal reasons and culture of openness, patients should be aware of this possibility especially if FA is managed conservatively.


  • Keywords


    Benign Breast lump; Benign Phyllodes Tumor; Breast lump excision; Fibroadenoma; Triple Assessment.

  • References


      [1] Kuijper A, Mommers EC, van der Wall E, van Diest PJ. Histopathology of fibroadenoma of the breast. Am J Clin Pathol. 2001; 115(5):736–742. [PubMed: 11345838] https://doi.org/10.1309/F523-FMJV-W886-3J38.

      [2] Dixon JM, Dobie V, Lamb J, Walsh JS, Chetty U. Assessment of the acceptability of conservative management of fibroadenoma of the breast. Br J Surg. 1996; 83:264–65. https://doi.org/10.1002/bjs.1800830238.

      [3] Willett, A.M., Michell, M.J. and Lee, M.J.R. (2010) Best Practice Diagnostic Guidelines for Patients Presenting with Breast Symptoms. (Department of Health).

      [4] Stavros AT, Thickman D, Rapp CL, Dennis MA, Parker SH, Sisney GA. Solid breast nodules: use of sonography to distinguish between benign and malignant lesions. Radiology 1995; 196(1):123–134). https://doi.org/10.1148/radiology.196.1.7784555.

      [5] London Cancer Surgical Guidelines for Breast Cancer http://www.londoncancer.org/media/134465/Surgical-Guidelines-for-Breast-Cancer-November-2015.pdf.

      [6] Dupont WD, Page DL, Parl FF, et al. Long-term risk of breast cancer in women with fibroadenoma. N Engl J Med. 1994; 331(1):10–15. [PubMed: 8202095] https://doi.org/10.1056/NEJM199407073310103.

      [7] Nassar, A, Visscher D.W., MD, Degnim A.C. Complex Fibroadenoma and Breast Cancer Risk: A Mayo Clinic Benign Breast Disease Cohort Study. Breast Cancer Res Treat. 2015 September; 153(2): 397–405. https://doi.org/10.1007/s10549-015-3535-8.

      [8] Lakhani SR, Ellis IO, Schnitt SJ, Tan, PH, van de Vijver MJ. World Health Organization Classification of Tumours of the Breast. Lyon: IARC Press; 2012. p. 143.

      [9] Lee, S., Mercado, C.L., Cangiarella, J.F., and Chhor, C.M (2017). Frequency and oucomes of biopsy-proven fibroadenomas recommended for surgical excision. Clin. Imaging. 50:31-36 https://doi.org/10.1016/j.clinimag.2017.12.008.

      [10] Yu-Ting Wu†, Shou-Tung Chen†, Chih-Jung Chen, Yao-Lung Kuo, Ling-Ming Tseng, Dar-Ren Chen, Shou-Jen Kuo and Hung-Wen Lai. Breast cancer arising within fibroadenoma: collective analysis of case reports in the literature and hints on treatment policy. World Journal of Surgical Oncology 2014 12:335. https://doi.org/10.1186/1477-7819-12-335.

      [11] Sanders, L.M. and Rana, S. (2015) The Growing Fibroadenoma. Acta Radiologica Open, 4, 1-5. https://doi.org/10.1177/2047981615572273.


 

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Article ID: 9457
 
DOI: 10.14419/ijm.v6i1.9457




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