Can Ultrasound Distinguish Between Sclerosing Adenosis and Fibroadenoma?

Can a breast ultrasound determine whether it is "sclerosing adenosis" or a simple fibroadenoma?

Dr.
Lee, I apologize for asking again: 1.
In your previous response, was it "possible" or "difficult" to determine whether it is an adenoma accompanied by "sclerosing adenosis" based on the ultrasound findings? If it is possible, what are the typical characteristics? 2.
In this recent 3D imaging, I have over ten adenomas or complex cysts.
Can I request my attending physician to remove the lesions that appear tumor-like on ultrasound (since I have a history of "sclerosing adenosis"; the cysts would be monitored for size and shape)? Is close monitoring a 6-month follow-up? 3.
Do both minimally invasive and traditional surgeries guarantee that all tissue can be completely removed? Thank you for your answers.

Sincere, 40~49 year old female. Ask Date: 2016/07/05

Dr. Li Zhonghuai reply Surgery

Hello! On ultrasound, it is easy to determine that it is an adenoma, with clear boundaries.
Fibroadenomas are mostly palpable, while sclerosing adenosis is often not palpable and has more ambiguous margins.
Sometimes, it can resemble breast cancer.
Regarding your concern about excising the mass, many patients share your thoughts, fearing the possibility of underlying ductal carcinoma in situ or future progression to invasive cancer, which mainly depends on whether atypical cells are present in the biopsy.
If atypical cells are observed, removal is recommended.
A follow-up in 3-6 months is acceptable.
Currently, there is no complete consensus on the treatment of sclerosing adenosis.
For small tumors (1-2 cm), it is recommended to excise the entire tumor, while for larger tumors (>4 cm), if complete excision would affect breast shape, a wide-core needle biopsy is suggested to ensure there is no accompanying malignancy.
Postoperative follow-up every 3-6 months is advisable; guaranteeing complete removal of multiple lesions is unlikely unless a significant amount of tissue is taken, followed by flap reconstruction.
Take care! Changhua Hospital is concerned about you!

Reply Date: 2016/07/05

More Info

When it comes to distinguishing between sclerosing adenosis and fibroadenoma using ultrasound, it is indeed a challenging task. Both conditions can present as palpable lumps in the breast and may appear similar on imaging studies. However, there are certain characteristics that can help differentiate between the two.

1. Ultrasound Characteristics:
- Fibroadenoma: Typically, fibroadenomas appear as well-defined, solid masses that are hypoechoic (darker than the surrounding tissue) on ultrasound. They often have a smooth contour and can exhibit a characteristic "wider than tall" shape. Fibroadenomas are usually mobile upon palpation and may have a homogeneous internal echogenicity.

- Sclerosing Adenosis: In contrast, sclerosing adenosis may present as a more complex mass with heterogeneous echogenicity due to the presence of fibrous tissue and glandular elements. It can also appear as a focal area of increased echogenicity or as a mass with irregular borders. Sclerosing adenosis may also be associated with microcalcifications, which can be better evaluated with mammography.

2. Management of Findings:
- Given your history of sclerosing adenosis and the presence of multiple masses, it is reasonable to discuss the option of excisional biopsy with your healthcare provider. If the ultrasound findings suggest that a mass is likely a fibroadenoma or if there are concerning features that warrant further investigation, your doctor may recommend surgical removal. The decision to excise should consider factors such as the size, shape, and characteristics of the masses, as well as your personal medical history.

- For complex cysts, monitoring their size and shape over time is a common approach. A follow-up ultrasound in 6 months is typical for assessing any changes in the characteristics of these cysts.

3. Surgical Considerations:
- Both minimally invasive techniques (such as ultrasound-guided core needle biopsy) and traditional surgical excision have their pros and cons. While minimally invasive procedures can effectively sample tissue for diagnosis, they may not always remove the entire lesion, especially if the mass is larger or has irregular borders. Traditional surgical excision, while more invasive, allows for complete removal of the lesion and thorough pathological examination. However, neither method can guarantee a 100% clean margin, and there is always a risk of residual disease.

In conclusion, while ultrasound can provide valuable information regarding breast masses, it may not definitively distinguish between sclerosing adenosis and fibroadenoma. A multidisciplinary approach involving imaging, clinical evaluation, and possibly biopsy is essential for accurate diagnosis and management. It is crucial to maintain open communication with your healthcare provider regarding your concerns and treatment options. Regular follow-ups and monitoring are key components in managing breast health, especially with a history of sclerosing adenosis.

Similar Q&A

Understanding Fibroadenomas: Diagnosis, Treatment, and Follow-Up Care

Hello Doctor: At the end of 2015, I had a mammogram that showed microcalcifications (but no clustered calcifications were detected). Following that, I underwent a breast ultrasound, which revealed a mass with calcifications on the right side (this mass was normal when I had a nee...

Dr. Zhou Jiazhen reply Breast and Thyroid
Dear Open Mind: 1. Sclerosing adenosis is a benign proliferation of the ductal epithelium of the breast, which is one of the changes associated with fibrocystic changes. Stromal sclerosis refers to the fibrosis of the tissue surrounding the ducts and glands of the breast. 2. ...

Understanding Core Needle Biopsy for Fibroadenomas and Sclerosing Adenosis

Hello Dr. Lee, I previously had two fibroadenomas excised, and the biopsy results indicated "sclerosing adenosis" and "hyperplasia." My most recent breast ultrasound showed approximately 11 lesions on both sides, and I am concerned that some of these may also ...

Dr. Li Zhonghuai reply Surgery
Hello! The more concerning condition is sclerosing adenosis. If atypical cells are observed in a core needle biopsy, it is recommended to remove the entire lesion to prevent the possibility of hidden carcinoma in situ. Ultrasound can help differentiate between "sclerosing ad...

Understanding Fibroadenomas: Concerns and Management Strategies

Hello Dr. Lee, I would like to briefly summarize my medical history: In 2016, I underwent a right mastectomy. Prior to the surgery, detailed examinations revealed a 1.5 cm tumor in my left breast. In July 2016, a core needle biopsy indicated it was a fibroadenoma. An MRI was als...

Dr. Li Zhonghuai reply Surgery
Hello! 1. The location of the fibroadenoma differs between two hospitals; one is on December 3rd (performed by a radiologist) and the other on January 2nd (performed by a physician). Why is there such a discrepancy? ==> The difference is not significant; it's purely a r...

Understanding Fibroadenomas and Cysts: What to Expect from Breast Ultrasound

Hello, I would like to ask about the breast ultrasound I had last October, which showed a fibrocystic lesion and a fibroadenoma on each side, both less than 0.5 cm. After six months of follow-up, the right side remains the same, while nothing was found on the left side. 1. Can ...

Dr. Chen Jiaming reply Surgery
Fibroadenoma is a solid tumor, while a fibrocyst is a cystic formation. Although both are influenced by hormones (such as the menstrual cycle), cysts tend to appear and disappear intermittently. In contrast, fibroadenomas are generally stable or may grow larger until they gradual...