Introduction:
Breast fibroadenoma is a smooth, firm lump of the breasts that often remains asymptomatic. Fibroadenoma is the most common benign mass of the breast that usually affects women between the age of 14 to 35 years; however, it can be found at any age. Breast fibroadenomas are rubbery masses with smooth borders of variable size. Fibroadenomas decrease in size after menopause; hence it is less common in post-menopausal women. It is highly mobile and referred to as a breast mouse.
What Are the Causes of Breast Fibroadenoma?
The etiology of breast fibroadenoma is debatable. But medical professionals believe that hormonal changes might be a possible cause of breast fibroadenoma. As the breast tissues are more sensitive to the female reproductive hormone estrogen, they usually increase in size during pregnancy and shrink during menopause. Therefore, there is an increased risk of fibroadenoma in females who take oral contraceptives before age 20.
It is found that about ten percent of the world's female population have breast fibroadenoma at least once in their lifetime. The incidence of breast fibroadenoma decreases as age increases. Fibroadenoma is usually two to three centimeters and might increase to more than 10 cm. It can cause breast hypertrophy.
What Are the Diagnostic Tools Used for Breast Fibroadenoma?
Biopsy -
A biopsy is needed to confirm the presence of breast fibroadenoma. Fine-needle biopsy is usually performed for breast fibroadenoma under the guidance of ultrasound to detect the correct location of the tumor for needle insertion. During fine-needle aspiration biopsy, a hollow needle is inserted into the tumor site, collecting a breast tissue sample. Then the sample is sent to the lab to determine the type and nature of the tissue. If the biopsy result is unclear, if the breast mass is growing faster, or if it causes pain, the entire mass should be removed.
Imaging Techniques -
1. Diagnostic Mammogram -
A mammogram is a two-dimensional X-ray technique used to detect breast abnormalities at an early stage. In a mammogram, fibroadenoma appears as a well-circumscribed oval-shaped mass that is hypodense or isodense. An involuting lesion in post-menopausal women contains calcification that resembles coarse popcorn calcification. Mammography sometimes provides false-negative results in dense breasts.
2. Breast Ultrasound -
-
In ultrasound, fibroadenoma appears as a round or oval mass with regular margins and hyperechoic, hypoechoic, or isoechoic masses. A thin echogenic layer usually surrounds it. If thickening is found around the region, it might be potential malignant lesions. Usually, the width of fibroadenoma is larger than its anteroposterior (AP) diameter. Microlobulations are often less than four.
-
The fat lobules of the breast appear as hypoechoic structures. The thin echogenic surrounding membrane is a typical sign of fibroadenoma. The fibroadenoma is usually not covered by a true capsule; the thin capsule surrounding the fibroadenoma is a pseudo capsule formed by the compression of fibroadenoma over the normal breast tissues.
-
Cyst inside the solid mass indicates osteosarcoma phyllodes rather than breast fibroadenoma. Ultrasound is more sensitive in diagnosing breast lesions, but it lacks specificity as most breast lesions are benign.
-
Breast ultrasound elastography is an advanced sonographic imaging tool. It provides detailed information on breast abnormalities in addition to breast ultrasound and mammography. It overcomes the limitations of mammography and ultrasound; it also determines the stiffness of the lesion; fibroadenomas are less stiff and have low vascularity.
3. Magnetic Resonance Imaging (MRI) -
In magnetic resonance imaging (MRI) breast, fibroadenoma appears as an oval or round mass, with lobulated, smooth borders enhanced with a gadolinium-based contrast agent. In T1 weighted images, fibroadenoma appears as hypointense or isointense structures. In T2 weighted images, it appears as hypo or hyperintense structures. In T1 gadolinium contrast-enhanced images, there is an initial slow contrast enhancement followed by a delayed phase.
What Is the Differential Diagnosis of Breast Fibroadenoma?
-
Breast cyst (a fluid-filled sac found inside the breast).
-
Breast carcinoma (cancer).
-
Phyllodes tumor (rare breast cancer that arises from the connective tissue of the breast).
-
Breast lymphoma (a rare type of painless non-Hodgkin lymphoma).
-
Tumor metastasis (cancer spreads from other sites to the breast).
How Is Breast Fibroadenoma Treated?
Fibroadenoma often does not require treatment as it shrinks and disappears on its own. However, surgery is recommended if the fibroadenoma grows larger or faster or causes any symptoms like pain.
-
Lumpectomy -
-
A lumpectomy or excisional biopsy is a surgical procedure to remove the lumps in the breast.
-
This procedure is performed under general or local anesthesia in which the lesion is removed through the incision placed over the target site.
-
Lumpectomy alters the shape of the breast and affects breast symmetry.
-
-
Vacuum-Assisted Excision Biopsy (VAB) -
-
Vacuum-assisted excision biopsy (VAB) is a non-surgical procedure to remove breast fibroadenoma.
-
This procedure is performed under local anesthesia in which the doctors insert a probe connected to a vacuum device through a small incision.
-
This vacuum device sucks out the breast fibroadenoma and is sent to the laboratory to determine the tissue type.
-
After the procedure, the patient may experience pain or bruise on the biopsy site.
-
-
Cryoablation -
-
Cryoablation is also a non-surgical treatment option for fibroadenoma. Cryoablation, also called cryotherapy, uses extreme cold to kill diseased tissues in the body.
-
During this procedure, patients may be given an intravenous line (IV) to administer a sedative to relax them.
-
Next, local anesthesia is given to numb the needle's insertion area. Then, a hollow needle-like wand called a cryoprobe is inserted into the target area guided by fluoroscopy.
-
Sometimes, multiple cryoprobes are required to destroy the abnormal tissues.
-
Once the cryoprobe is inserted into the intended site, they deliver liquid nitrogen, liquid nitrous oxide, or compressed argon gas.
-
Conclusion:
Breast elastography has shown that they are highly specific in detecting breast fibroadenomas. Non-enhancing internal septations are visible in T2 weighted images of MRI. According to the American Board of internal medicine, fibroadenoma does not require surgery when smaller than two centimeters. Surgery is often not required for breast fibroadenoma, so patients are instructed to have follow-up visits. A breast ultrasound is taken during each follow-up visit to determine the size and shape of the breast mass.
