About
A fibroadenoma is a solid breast lump. This breast lump is not cancer. A fibroadenoma happens most often between ages 15 and 35. But it can be found at any age in anyone who has periods.
A fibroadenoma often causes no pain. It can feel firm, smooth and rubbery. It has a round shape. It might feel like a pea in the breast. Or it may feel flat like a coin. When touched, it moves easily within the breast tissue.
Current Treatment Methods
Currently, the common treatments for breast fibroadenoma are open surgical excision, vacuum-assisted breast biopsy (VABB) technique, high-intensity focused ultrasound (HIFU) or cryoablation. VABB is a surgical alternative with small skin incision for the management of fibroadenoma up to 3 cm in size; Cryotherapy involves freezing the lesion by inserting a cryoneedle into its center under local anesthesia; HIFU is a thermoablative technique that delivers energy to a confined space leading to protein denaturation and coagulative necrosis at a temperature of >65 °C.
What are the benefits of HIFU?
◼ It is non invasive, which means faster recovery comparing to surgery
◼ Only sedation, no anesthesia required
◼ Not involve probe insertion, thus avoiding scars
◼ Lower treatment risks
◼ Precise ablation without damaging surrounding tissues
Am I suitable to undergo HIFU?
Suitable Indications:
◼ Patients were more than 18-year-old
◼ BI-RADS grade ≤ 3 by ultrasonography
◼ Diagnosis of breast fibroadenoma was confirmed by core needle biopsy
◼ Size of lesion was between 5–40 mm
*Please be noted the above criteria is only for reference, whether a patient can be applied HIFU shall be further confirmed by HIFU doctors after diagnosis.
Contraindications:
◼ Have previous breast implants
◼ Being pregnant or lactating
◼ Have received any laser or radiation therapy to the ipsilateral breas
◼ If epithelial atypia was seen on histopathology
◼ If there was any suspicion of a phyllodes tumour
Effectiveness of HIFU
Symptom Relief
Recently, HIFU has been used in many studies for breast tumors. Some scholars found breast tumor cells with presence of coagulative necrosis after HIFU treatment. For example, in a study of 27 patients successfully completed HIFU treatment, effective treatment (65% volume reduction) after 6 months was reported in 19 patients (70%), and after 12 months in 24 patients (89%) (Figure 4). The mean relative volume reduction after 6 months was 61.6% and after 12 months 84.8%.
In another study of 20 patients with 26 breast fibroadenomas who underwent USgHIFU, FA volume decreased significantly as soon as at 1-month follow-up (median 1.44 mL, range 0.21–5.18 mL, p < 0.001 compared with the initial value), and continued to reduce until the 24-month visit (median 0.35 mL, range 0.06–1.21 mL; p < 0.001 compared with the initial value).
Histological Outcome
After 12 months, the lesion was no longer visible on ultrasound in four cases, one patient was pregnant and another patient refused CNB. The other 21 patients who presented with sonographically indistinct residues underwent CNB. In 18/21 cases (86%) no more vital fibroadenoma cells were reported, while in 3/21 cases (14%) vital residues were found.
1. Hahn M, Fugunt R, Schoenfisch B, Oberlechner E, Gruber IV, Hoopmann U, Roehm C, Helms G, Taran FA, Hartkopf AD, Warzecha H, Wiesinger B, Brucker SY, Boeer B. High intensity focused ultrasound (HIFU) for the treatment of symptomatic breast fibroadenoma. Int J Hyperthermia. 2018;35(1):463-470. doi: 10.1080/02656736.2018.1508757. Epub 2018 Sep 11. PMID: 30204024.
2. Kovatcheva R, Zaletel K, Vlahov J, Stoinov J. Long-term efficacy of ultrasound-guided high-intensity focused ultrasound treatment of breast fibroadenoma. J Ther Ultrasound. 2017 Mar 16;5:1. doi: 10.1186/s40349-017-0083-1. PMID: 28331611; PMCID: PMC5353785.
Safety of HIFU
Common complaints during HIFU ablation in the management of breast fibroadenomas include skin burn and mild pain of treatment area.
In a study to evaluate the safety for HIFU treatment of symptomatic breast fibroadenoma, among 27 patients, one patient (4%) presented with pain and sonographic signs of fat necrosis 9 months after treatment. Despite analgesia, the pain lasted until surgical excision 18 months after HIFU.
Hahn M, Fugunt R, Schoenfisch B, Oberlechner E, Gruber IV, Hoopmann U, Roehm C, Helms G, Taran FA, Hartkopf AD, Warzecha H, Wiesinger B, Brucker SY, Boeer B. High intensity focused ultrasound (HIFU) for the treatment of symptomatic breast fibroadenoma. Int J Hyperthermia. 2018;35(1):463-470. doi: 10.1080/02656736.2018.1508757. Epub 2018 Sep 11. PMID: 30204024.
Case Study
Volume measurement before treatment (A), 6 months (B) and 12 months (C) after treatment