Fibroadenomas

Project 10 of 12

Fibroadenomas are benign tumors of the breast and seen in about 10% of healthy women. They are most commonly diagnosed between 15-30 years of age. Since they are stimulated by the estrogen, they grow in pregnancy and shrink in menapause. Histologically, fibroadenomas are composed of fibroid and glandular tissue. They may be single or multiple, and when multiple, the risk of developing breast cancer may be slightly higher.

With manual examination, fibroadenomas are palpated as round/oval, firm and mobile masses with smooth contours. Because of their high mobility, they are also called “breast mice”. In more than 90% of the cases, fibroadenomas are less than 3 cm in size, although giant fibroadenomas exceeding 10cm in diameter may also occasionally be seen.

How are they diagnosed?

Most fibroadenomas are detected during the manual examination performed by the doctor or the patient herself. On mammography and ultrasound, they are typically seen as round-oval and well defined masses. Although these findings are typical of fibroadenoma, definitive diagnosis can only be made by biopsy. The ideal biopsy technique for breast fibroadenomas is ultrasound-guided core biopsy.

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How are they treated?

If the fibroadenoma is small, does not grow or cause symptoms, and the diagnosis is proven with biopsy, then a regular ultrasound follow-up is generally all that is required. If however, the fibroadenoma is large, grows or cause symptoms, then treatment is indicated. In routine practice, some of the patients for whom only follow-up is recommended, may also prefer to be treated. The classic treatment of fibroadenoma is surgical operation (lumpectomy). Although surgery can completely remove any fibroadenoma, it has some disadvantages for the patients and also for the doctors:

  • A large scar tissue may develop at the operation site, which is aesthetically not desirable in the breast.
  • If a large fibroadenoma is operated, a depression or deformation may develop at the skin.
  • The scar tissue at the operation site may mimic breast cancer on mamography and ultrasound, which may cause patient anxiety, unnecessary follow-up and biopsy.
  • If the patient has multiple fibroadenomas, these disadvantages multiply and surgery may become an unacceptable treatment option.

Nonsurgical treatment methods:

These methods can be divided into two main groups.

  1. Treatments that destroy fibroadenomas in the breast and make them gradually smaller (cryoablation and laser ablation).
  2. Treatments that remove fibroadenomas from the breast (BLES, vacuum biopsy).

In cryoablation and laser ablation, first the skin is numbed with local anesthetic, and a special needle is placed through the skin into the center of the fibroadenoma under ultrasound guidance. Then the fibroadenoma is destroyed either by freezing (cryoablation) or by burning (laser ablation). The fibroadenoma becomes dead and progressively smaller by time. Its symptoms will also decrease or disappear completely.

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Cryoablation and laser ablation have been used for a long time and their safety and effectiveness have been scientifically proven in breast fibroadenomas. Both methods were approved by the Food and Drug Administration (FDA) for the treatment of fibroadenomas long time ago. In general, laser ablation is regarded suitable for fibroadenomas upto 2cm in size, and cryoablation, upto 4cm in size. Although both methods proved successful in fibroadenoma treatment, there is more worldwide experience with cryoablation.

In the treatment of fibroadenomas, cryoablation and laser ablation have several advantages over the surgical operation:

  • They are performed under local anesthesia.
  • There is no skin incision, stitches and scar after the treatment.
  • After the treatment, while fibroadenoma shrinks slowly over time, the normal breast tissue also grows and fills the space that occurs. As a result, no skin depression or deformation occur.
  • If the patient has multiple fibroadenomas, all the tumors can be treated in one single session. This may reduce the cost and increase patient satisfaction.

In the other group of nonsurgical treatments, fibroadenomas are removed through a 3-5mm skin incision using BLES or vacuum biopsy. In BLES (Breast Lesion Excision System), a 5mm skin incision is made under local anesthesia, and the BLES needle is advanced to the fibroadenoma. When the system is turned on, special wires exit from the needle, go around the fibroadenoma and reach its other end. When the wires go around the fibroadenoma, they burn the tissue with radiofrequency energy and cut the the fibroadenoma off the surrounding tissue. When the wires reach the other end of the fibroadenoma, they get locked and grasp the tumor firmly. Then, the whole fibroadenoma can be pulled out and removed completely. BLES is able to remove the fibroadenoma just like in surgery. However, it has some advantages and disadvantages:

Advantages:

  • BLES is done under local anesthesia.
  • There is practically no bleeding because the wires burn the tissue while cutting.
  • The skin incision is much shorter than that of surgery (only 5mm) and can be closed with a single stitch.

Disadvantages:

  • For each fibroadenoma, a separate BLES needle has to be used. This may increase cost in multiple fibroadenomas.
  • BLES is able to remove fibroadenomas upto 2.5cm in diameter. Thus, larger fibroadenomas can not be completely treated with this method.

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Vacuum biopsy is a system that has been originally developed to obtain multiple and large tissue samples for the diagnosis of suspected breast masses. In this system, a large needle is advanced into the suspected tumor, and when the system is turned on, large tissue samples are cut and collected into a reservoir by aspiration. When this is repeated continuously, a tumor can be completely removed in small pieces. Vacuum biopsy system has been successfully used in the treatment of fibroadenomas. Just like the BLES, it is able to remove the fibroadenoma through a very small skin incision under local anesthesia. However, unlike BLES, it takes longer and cause more bleeding.

In some situations, it may be advantageous to use these treatments in combination. For example, large fibroadenomas can first be ablated and made smaller with cryoablation or laser ablation, and when their diameter becomes less than 2.5cm, they can be completely removed with BLES. In this way, even very large fibroadenomas can be completely cured under local anesthesia through a very small skin incision.

 Click to see the video on nonsurgical treatments of fibroadenomas

Interventional Treatments