Should All Biopsy-Proven Complex Fibroadenomas Be Excised?

The objective of a recent study was to review clinical characteristics and outcomes of complex fibroadenomas from a single academic institution.

The study has concluded that complex fibroadenomas and simple fibroadenomas can be managed similarly.

Participants
Retrospective review of 63 biopsy-proven complex fibroadenomas.

Methodology
Comparison of simple and complex fibroadenomas was performed for size, age of patients, histopathology, and follow-up outcomes.

Results
63 (16%) complex fibroadenomas were identified among 401 consecutive fibroadenomas biopsied in the study. Mean size of complex fibroadenomas was 50% of that of simple fibroadenomas. Average age of patients with complex fibroadenomas was significantly older than those patients with simple fibroadenomas.

The most common mammographic features of complex fibroadenomas were well-defined masses, and the majority manifested as circumscribed hypoechoic or isoechoic masses on sonography. Histopathology of complex fibroadenomas showed simple fibroadenomas with presence of additional benign entities such as sclerosing adenosis, apocrine metaplasia, cyst, and calcifications.

Excisional biopsy of 63% of complex fibroadenomas was performed. Among these excised complex fibroadenomas, 1 invasive lobular carcinoma and 1 benign phyllodes tumor were found. The complex fibroadenoma with invasive lobular carcinoma initially showed complex fibroadenoma with atypical lobular hyperplasia on the core needle biopsy. In total, 33% of complex fibroadenomas underwent imaging follow-ups and no malignancy was identified during the 24-month follow-up period.

Conclusions
Management recommendations of complex fibroadenomas should be similar to that of simple fibroadenomas.

Reviewer’s Comments
Complex fibroadenomas represent approximately 15% to 22% of fibroadenomas of the breast. Complex fibroadenomas are associated with slightly increased (3.1 times to 3.72 times) risk for developing breast cancer.

Histopathologically, complex fibroadenomas are simple fibroadenomas with additional complex features such as sclerosing adenosis. The imaging findings of simple fibroadenomas and that of complex fibroadenomas are similar.

Average age of patients with complex fibroadenomas is significantly older than those patients with simple fibroadenomas.

Currently, there is variability in management of biopsy-proven fibroadenomas. The Results of this study suggest that both simple fibroadenomas and complex fibroadenomas can be managed similarly.

Author: Bokran Won, MD
Reference:
Sklair-Levy M, Sella T, et al. Incidence and Management of Complex Fibroadenomas. AJR; 2008; 190 (January): 214-218