Breast Lumps: Insights on Fibroadenomas and Treatment Options

Breast lump

Hello, Dr.
Tsai.
Three months ago, I discovered a lump in my right breast.
Today, I had an examination and an ultrasound, and the doctor said it is a 3 cm benign fibroadenoma.
He suggested surgery to remove it, as waiting for it to grow larger would require general anesthesia, while it can currently be done with local anesthesia.
I would like to ask the doctor: 1.
Can an ultrasound determine if it is benign? 2.
What is the accuracy of this method? 3.
If I do not have surgery, will it turn malignant? 4.
After surgery, will the same tumor grow back? What is the recurrence rate? Thank you, doctor.
I am very worried and concerned.

Mei Mei, 20~29 year old female. Ask Date: 2005/06/22

Dr. Cai Yonglong reply Obstetrics and Gynecology

Dear Mei Mei,
Dr.
Tsai Yong-long, the Director of the Department of Obstetrics and Gynecology at Tainan Hospital, Department of Health, Executive Yuan, would like to inform you: On ultrasound, if the appearance is smooth and the internal density is uniform, it is mostly benign; if the appearance is irregular and the internal density is heterogeneous, it may be malignant.
The accuracy is about 60-70%.
If there are any suspicions, a biopsy or aspiration should be performed.
If surgery is not performed, regular follow-up is necessary.
Even after surgery, there is a possibility of growth in other areas, so regular check-ups are still required.

Wishing you good health and all the best!
Sincerely,
Tainan Hospital

Reply Date: 2005/06/22

More Info

Understanding breast lumps, particularly fibroadenomas, is crucial for patients who may be facing the decision of whether to undergo surgery or to monitor the condition. Fibroadenomas are benign tumors composed of glandular and stromal (connective) tissue, and they are among the most common types of breast lumps found in women, especially those in their reproductive years.

1. Can ultrasound determine if a lump is benign?
Ultrasound is a valuable tool in the evaluation of breast lumps. It can help differentiate between solid masses (like fibroadenomas) and cystic lesions (fluid-filled sacs). Typically, benign fibroadenomas appear as well-circumscribed, solid masses on ultrasound, often described as having a homogeneous echogenicity. However, while ultrasound can provide significant information, it is not definitive. The characteristics observed on ultrasound can suggest benignity, but a biopsy is often necessary for a conclusive diagnosis.

2. What is the accuracy of ultrasound?
The accuracy of ultrasound in diagnosing breast lumps can vary. Studies suggest that ultrasound has a sensitivity of about 85-90% for detecting breast cancer, but its specificity can be lower. This means that while ultrasound is good at identifying potential issues, it may not always accurately distinguish between benign and malignant lesions. Therefore, if a lump is suspicious or if there are concerning features, a biopsy is often recommended to obtain a definitive diagnosis.

3. If I don’t have surgery, will the lump become malignant?
Fibroadenomas are generally considered benign and do not typically transform into cancer. However, there are rare cases where a complex fibroadenoma may have atypical features that could warrant closer monitoring. The majority of fibroadenomas remain stable or may even shrink over time, especially after menopause. Nevertheless, if a lump is growing or changing, it is essential to follow up with your healthcare provider to determine the best course of action.

4. Will the tumor recur after surgery?
Surgical removal of a fibroadenoma is usually curative, and the recurrence rate is relatively low. However, it is possible for new fibroadenomas to develop in the breast tissue, particularly in younger women. The likelihood of recurrence or the development of new lumps can depend on various factors, including hormonal influences and individual risk factors. Regular follow-up with your healthcare provider is essential to monitor for any new changes.

In conclusion, while the prospect of surgery can be daunting, it is often the most definitive way to address a fibroadenoma, especially if it is symptomatic or growing. The decision to proceed with surgery should be made in consultation with your healthcare provider, considering your specific situation, the characteristics of the lump, and your overall health. Regular monitoring and communication with your doctor can help alleviate concerns and ensure that any changes are promptly addressed. If you have further questions or concerns, do not hesitate to reach out to your healthcare team for personalized guidance.

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