Breast ImagingE3014. Frequency and Outcomes of Biopsy-Proven Fibroadenomas Recommended for Surgical Excision
Lee S1, Mercado C1, Cangiarella J1, Chhor C.1 1. New York University School of Medicine, New York, NY
Address correspondence to S. Lee (Shimwoo.Lee@med.nyu.edu)
Objective: Surgical consultation for excision is often recommended for fibroadenomas greater than 2 cm at the time of presentation, or for those fibroadenomas that have increased in size at imaging follow-up. This is due in part to a concern of under diagnosing a more aggressive lesion, such as a phyllodes tumor. We investigated the surgical outcomes of fibroadenomas to better understand the impact of the current recommendations.
Materials and Methods: A retrospective review was performed by searching for “fibroadenoma” and “surgical consultation” in our institutional electronic medical records from January 2007 to December 2015. The search identified 391 cases. Cases were excluded if the patient was male, less than 21 or over 90 years old, had a known history of breast cancer, or if fibroadenoma was less than 2 cm without interval growth, leaving 172 cases of biopsy-proven fibroadenomas that were recommended for surgical consultation. Pathology, radiology, and clinical reports were reviewed. Outcomes were recorded, including whether the fibroadenoma was excised or followed by imaging studies.
Results: Of 172 patients with biopsy-proven fibroadenomas recommended for surgical consultation, the median age of the patients was 34 years and the average size of the fibroadenomas was 2.7 cm (range, 0.8–9.6 cm). There were 107/172 fibroadenomas (62%) initially sampled through fine needle aspiration (FNA) biopsy, and the remaining (38%) were sampled with core needle biopsy (CNB). Of 172 cases sent for surgical consultation, follow-up was available in 116 (67%). Of these, 64 cases (55%) were surgically excised, 4/64 (6%) of which were upgraded to benign phyllodes tumors upon histopathologic examination. The remaining 52 (45%) cases underwent imaging follow-up after initial biopsy, with an average duration of 1.9 years (range, 0.5–7.6 years), and 23/52 (44%) cases showed additional interval growth on imaging and surgical consultation was recommended again. Of these 23, 16 (70%) cases subsequently underwent surgery, 2/16 (13%) of which were upgraded to benign phyllodes tumor. In total, 80/172 (47%) cases that were recommended for surgical consultation underwent excision, and 6/80 (8%) were upgraded. The median age of patients with phyllodes tumors was 32 years, and the average size of these lesions was 2.3 cm. Four of the six (67%) cases with phyllodes tumors had initial biopsy with FNA, and the rest had CNB. Half of the phyllodes cases underwent a second excision to remove any residual tumor.
Conclusion: Approximately half (47%) of biopsy-proven fibroadenomas that are recommended surgical consultation actually undergo excision, 8% of which are upgraded to phyllodes tumors. This suggests that the current recommendation does help to detect and remove concerning lesions initially biopsied as fibroadenomas. Therefore, encouraging patients to follow-up with recommendations is crucial so that such lesions are not missed.