Cryosurgical ablation of fibroadenomas – pro
Fibroadenoma is a common benign neoplasm occurs most frequently in young women, usually within 20 years after puberty. It is somewhat more frequent and tends to occur at an earlier age in black women. Multiple tumors are found in 10–15% of patients.
No treatment is usually necessary if the diagnosis can be made by needle biopsy or cytologic examination. Excision or vacuum-assisted core needle removal with pathologic examination of the specimen is performed if the diagnosis is uncertain. In a 2005 study, cryoablation, or freezing of the fibroadenoma, appears to be a safe procedure if the lesion is consistent with fibroadenoma on histology prior to ablation. Cryoablation is not appropriate for all fibroadenomas because some are too large to freeze. The advantages of cryoablation over observation are not clear. One problem that cryoablation can present is that is usually not possible to distinguish a large fibroadenoma from a phyllodes tumor on the basis of needle biopsy results.
In 2005, the American Society of Breast Surgeons issued a consensus statement regarding management of fibroadenomas of the breast that states, “Several multi-institutional trials have demonstrated cryoablation to be a successful option for the resolution of fibroadenomas without surgical excision…Results of cryoablation have been followed out to 4 years and demonstrate the procedure to be safe, efficacious, and durable… Both techniques, in the setting of this benign disorder, are considered low risk for patients who could, if required, undergo surgical resection for unsuccessful (incomplete excision) treatment. The Society will continue to monitor outcomes to provide updated guidance as future multi- and single institutional registry data are reported at meetings and in the breast surgery literature.”
Hartmann LC et al: Benign breast disease and the risk of breast cancer. N Engl J Med 2005;353:229. [PMID: 16034008]
Kaufman CS et al: Office based cryoablation of breast fibroadenomas with long-term follow-up. Breast J 2005;11:344
The American Society of Breast Surgeons. Consensus statement: management of fibroadenomas of the breast. www.breastsurgeons.org