Fibroadenomas: Concerns and Management Strategies

The concerns of fibroepithelial tumors?

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 also performed, and the report confirmed the same diagnosis of fibroadenoma, after which I continued to be monitored.
In May 2017, a PET scan showed no FDG uptake in the fibroadenoma.
A color Doppler ultrasound in May 2017 did not show increased blood flow, only vessels circling the edges, and the size remained similar.
In August 2017, a mammogram revealed benign scattered microcalcifications but did not capture the fibroadenoma.
The imaging was classified as BI-RADS 2 (as I have dense breast tissue).
In August 2018, a mammogram showed scattered microcalcifications, and the fibroadenoma appeared oval, with indistinct borders and high density, classified as BI-RADS 0.
An ultrasound was performed that same day, and the breast surgeon advised continued monitoring.
However, the surgeon's tone when discussing the mammogram report was quite concerning, suggesting that different management might arise after the ultrasound.
Due to overcrowding in large hospitals and the fact that most patients do not request their medical records or understand their conditions, I often find that when I consult doctors, they frequently do not answer my questions or believe I do not need to know so much.
Therefore, I would like to ask you:
1.
The location of the fibroadenoma differs between two hospitals: one report states it is at 12 o'clock (performed by a radiologist), while the other states it is at 1 o'clock (performed by a physician).
Why might there be such a discrepancy? (It feels like these two locations are quite far apart, but I am certain it is the same lesion.)
2.
Since June 2017, I have been receiving menopause injections and taking Raloxifene.
What impact does this have on the fibroadenoma? I have read that some doctors believe fibroadenomas may shrink or disappear after menopause.
Could the menopause injections cause the fibroadenoma to age or change shape?
3.
Given my medical history and the current status of the fibroadenoma, do you recommend minimally invasive excision? (The lesion is located deeper and cannot be palpated.)
4.
After undergoing so many examinations over the past two years, can we rule out the possibility of malignancy? Is continued monitoring sufficient?
Thank you for taking the time to respond, and I appreciate your hard work.

Wang, 40~49 year old female. Ask Date: 2018/08/12

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 record, and it's not possible to measure it precisely.
2.
Since June 2017, I have been receiving menopause injections and taking Raloxifene.
What is the impact of this on the fibroadenoma? I have seen some doctors suggest that fibroadenomas may shrink or disappear after menopause.
Could the menopause injections cause the fibroadenoma to age and change shape? ==> It may shrink or not change much.
3.
Given my medical history and the current condition of the fibroadenoma, does Dr.
Lee recommend minimally invasive removal? (The location is deeper and cannot be palpated.) ==> The likelihood of the fibroadenoma becoming malignant is extremely low; however, one should be cautious as phyllodes tumors can also present similarly to fibroadenomas on core needle biopsies.
Based on your situation, removal is recommended.
Minimally invasive surgery is not necessary; the incision can be made close to the areola to hide the scar along its edge.
4.
After so many tests over the past two years, can we rule out the possibility of malignancy? Should I just continue monitoring? ==> Given that you have a malignant tumor in your right breast and considering your age, it is advisable to remove the one on the left side as well.
Wishing you well! Changhua Hospital cares about you!

Reply Date: 2018/08/12

More Info

Dear Patient,
Thank you for sharing your detailed medical history regarding your fibroadenoma and the various imaging studies you have undergone. I understand that navigating through medical information can be overwhelming, especially when it comes to concerns about breast health. Let’s address your questions one by one.

1. Differences in Imaging Locations: The discrepancy in the reported location of your fibroadenoma between the two hospitals could be attributed to several factors. First, the interpretation of imaging studies can vary slightly between radiologists, especially if they are using different imaging modalities or techniques. Additionally, the positioning of the breast during imaging can affect the perceived location of a lesion. It’s also possible that the fibroadenoma has slightly shifted or changed in size, which can occur over time. If you have concerns about this discrepancy, I recommend discussing it with your healthcare provider, who may suggest further imaging or a consultation with a breast specialist.

2. Impact of Menopause and Medications on Fibroadenomas: Fibroadenomas are benign tumors that are influenced by hormonal changes in the body. It is true that some studies suggest that fibroadenomas may decrease in size or even resolve after menopause due to the reduction in estrogen levels. However, the use of medications such as GnRH agonists (like the one you mentioned, which induces a temporary menopause) can also affect the size and characteristics of fibroadenomas. While it is possible that the fibroadenoma may change in response to hormonal fluctuations, the exact impact can vary from person to person. Regular monitoring through imaging is essential to assess any changes.

3. Recommendation for Surgical Intervention: Given your history and the benign nature of fibroadenomas, the decision to proceed with surgical excision should be based on several factors, including the size of the fibroadenoma, any changes observed in imaging studies, and your personal preferences. If the fibroadenoma is stable and not causing any symptoms, many healthcare providers recommend continued surveillance rather than immediate surgical intervention. However, if there are concerns about changes in the lesion or if it becomes symptomatic, a minimally invasive approach may be considered. A discussion with your breast surgeon about the risks and benefits of surgery versus continued monitoring would be beneficial.

4. Exclusion of Malignancy: The extensive imaging you have undergone over the past two years, including mammograms and ultrasounds, has likely provided a good indication that the fibroadenoma is benign. Fibroadenomas typically do not have malignant potential, especially when stable over time and without concerning features on imaging. However, it is essential to maintain regular follow-ups as recommended by your healthcare provider to ensure that any changes are promptly addressed.

In summary, while your fibroadenoma appears stable and benign based on your imaging history, it is crucial to maintain open communication with your healthcare team. Regular monitoring and follow-up imaging are key strategies in managing fibroadenomas. If you have further concerns or if there are changes in your condition, do not hesitate to reach out to your healthcare provider for personalized advice.

Thank you for your patience, and I wish you the best in your health journey.

Sincerely,
Doctor Q&A Teams

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