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Fibroadenoma

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Abstract

The common breast fibroadenoma makes up between one-third and one-half of biopsies for benign breast disease. The contemporary view is that it is an abnormality of normal development and involution rather than a neoplasm. Various other benign conditions may be clinically indistinguishable, and histological confirmation was only obtained in 68% of 321 masses thought to be fibroadenomas. Short-term (13–24 mo) follow-up of 201 masses, thought to be fibroadenomas on clinical and cytological grounds, showed resolution in 31% and regression in a further 12%, this behavior being more common with single lesions; a further 32% increased in size. There have been no long-term studies, but it is likely that most regress toward the end of a woman's reproductive years. Aspiration cytology can differentiate malignant from benign disease with great accuracy, but had impaired sensitivity (87%) and specificity (76%) in differentiating fibroadenoma from other benign processes in an analysis of 244 successful aspirates. While these lesions may be safely left in women under 25 years of age, only 19 (27%) of 70 women of this age group chose this option and excision remains the most frequent treatment.

Résumé

Le fibroadénome, fréquent, est l'objet du tiers à la moitié de toutes les biopsies pratiquées pour les maladies bénignes du sein. Le point de vue contemporain voudrait que le fibroadénome soit une anomalie du développement et de l'involution plutôt qu'une néoplasie. Il se distingue cliniquement parfois mal des autres maladies bénignes; la confirmation histologique n'a été obtenue que pour 68% des 321 masses prises pour des fibroadénomes. Le suivi à court terme (13 à 24 mois) de 201 masses prises cliniquement et cytologiquement pour des fibroadénomes, surtout lorsqu'elles étaient solitaires, a montré une régression dans 31% des cas et une diminution dans 12%. Par contre, 32% des lésions ont augmenté de volume. Il existe peu d'études à long terme, mais il est probable que la plupart des lésions régressent vers la fin de la période de sécrétion hormonale. La cytoponction peut aider à distinguer les tumeurs bénignes des tumeurs malignes avec une grande précision; cependant, dans une série de 244 cytoponctions réussies, cette méthode a été trouvée peu sensible (87%) et peu spécificique (76%) pour différencier les fibroadénomes des autres lésions bénignes. Alors qu'on peut laisser en place ces lésions avec peu de risque chez la femme agée de moins de 25 ans, seulement 19 (27%) ont opté pour cette solution. L'excisison reste donc le traitement le plus fréquemment pratiqué.

Resumen

El fibroadenoma común de la glándula mamaria representa entre un tercio y la mitad de las biopsias que se realizan para enfermedad mamaria benigna. El punto de vista contemporáneo es que se trata de una anormalidad del desarrollo e involución, más que un neoplasma verdadero. Variadas entidades benignas pueden ser clínicamente indiferenciables del fibroadenoma; la confirmación histológica fué obtenida solamente en 68% de 321 masas consideradas como fibroadenomas. El seguimiento a corto plazo (13–24 meses) de 201 masas consideradas como fibroadenomas sobre bases clínicas y citológicas demostró resolución en 31% y regresión en otro 12% de los casos, comportamiento que apareció más frecuente cuando la lesión era única; un 32% adicional exhibió aumento de tamaño. Aunque no existen estudios a largo plazo, es probable que la mayoría de los fibroadenomas regrese hacia el final de la vida reproductiva de la mujer. La aspiración para citología puede establecer la diferenciación entre enfermedad maligna y benigna con gran precisión, pero demuestra limitado sensibilidad (87%) y especificidad (76%) en la diferenciación entre fibroadenoma y otras entidades benignas, según el análisis efectuado en 244 aspirados. En tanto que estas lesiones pueden ser simplemente observadas en mujeres menores de 25 años de edad, sólo 19 (27%) de 70 mujeres en este grupo de edad escogieron tal opción y la resección sigue siendo la forma más frecuente de tratamiento.

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Dent, D.M., Cant, P.J. Fibroadenoma. World J. Surg. 13, 706–710 (1989). https://doi.org/10.1007/BF01658418

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