MANAGEMENT OF FIBROADENOMA OF THE BREAST

Fibroadenoma is a common cause of discrete breast lumps in young women . There is agreement that fibroadenomas can be diagnosed preoperativel y with a high degree of confidence and that some of the lesions thus d iagnosed will resolve, possibly obviating the need for excision. There is, however, wide disagreement over the proportion of fibroadenomas t hat resolve spontaneously and therefore the benefit that accrues from an expectant policy. The aim of this study was to audit the management of fibroadenomas on one unit and clarify their natural history over a 5-year period. A cohort of 70 women with 87 fibroadenornas diagnosed using a triple assessment of clinical examination, cytology and imagin g (sonomammography) have been followed for a minimum of 5 years. In al l, 53 of the 'fibroadenomas' have been excised. In four cases the hist ology revealed benign disease other than fibroadenoma; there were no n eoplasms. The sensitivity of cytology and sonomammography for the diag nosis of fibroadenoma were 84% and 98% respectively. Thirty-four fibro adenomas have not been excised. Of 25 fibroadenomas that have been rea ssessed after at least 5 years of follow-up, 13 (52%) have reduced in size, 4 (16%) are unchanged in size and 8 (32%) have grown. No patient has developed a carcinoma at the site of the presumed fibroadenoma. T his study confirms that an expectant management policy of fibroadenoma s has not resulted in misdiagnosis of carcinomas. Further, since a sig nificant proportion of fibroadenomas remain static or reduce in size o ver a 5-year period many women can avoid excision.