Unnecessary Biopsy For Fibroadenomas, How Can We Decrease Its Rate?

Yıl 2017, Cilt: 4 Sayı: 3, 13 - 18, 01.12.2017

Emrah Doğan , Leyla Tekin , Neşat Çullu , Murat Polat

Öz

Fibroadenoma (FA) is
benign form of tumors of the breast with a very low risk of transformation to
malignity. It is very common among young women and incidence drops with age.
Diagnosis is often made by ultrasonography (US). Instead of excision for
diagnosis, following is made by imaging. Currently, FA amount for about half of
the biopsies of breast.  The objective of
our study is to find by which mean we can decrease the rate of unnecessary
biopsies. We made a retrospective study on 39 patients labelled as FA (mean age
48.8±7.7 years). We analyzed the features of lesions in US: size, localization,
contour, orientation, homogeneity, echogenicity, single or multiple, presence
or absence of calcifications. We classified our masses according to BIRADS
categorization and also calculated the rate of masses according to indications
of biopsies. Concerning the ultrasonographic description of FA’s features, all
of our findings were compatible with literature. Except one patient, all of
them were classified as less suspicious according to BIRADS categorization. 2/3
of biopsies in our sample were made in the first examination and 1/3 presented
suspicious features. A high amount of biopsy is indicated in the first contact
with patients because there is no previous examination to refer to. We suggest
to not wait for patient to be aware of the mass or for systematic examination
set at the age of 40 and to make earlier US in purpose to have a documented
reference of masses’ features which are well established according to
literature in order to avoid unnecessary biopsies. 

Anahtar Kelimeler

Fibroadenoma, Breast, Tru-cut Biopsy, Ultrasonography

Fibroadenomlara Yapılan Gereksiz Biyopsiler, Nasıl Oranlarını Düşürebiliriz?

Öz

Fibroadenoma malign
transformasyon riski çok düşük olan benign formda bir meme tümörüdür. Genç
yaşta daha yaygındır ve insidansı yaş ile düşer. Tanısı sıklıkla ultrasonografi
ile konur. Eksizyon yerine genellikle radyolojik izlem yapılır. Buna rağmen
meme biyopsilerinin yarısı fibroadenomlara yapılmaktadır. Araştırmamızın konusu
fibroadenomlara yapılan gereksiz biyopsilerin nasıl düşürülebileceği
hakkındadır. Araştırma Fibroadenom
tanısı almış 39 hastayı kapsayan retrospektif bir çalışmadır. (ortalama yaş
48.8±7.7). Ultrasonografi ile lezyonların özellikleri
analiz edildi. Boyut, lokalizasyon, kontür, oryantasyon, homojenite, ekojenite,
tek ya da multipl olması, kalsifikasyon özelliklerine göre sınıflandırıldı .
Ayrıca  lezyonların BIRADS grupları
belirtildi. Son olarak lezyonlar biyopsi yapılma nedenlerine göre
sınıflandırıldı. Lezyonların
ultrasonografik özellikleri ile ilgili tüm bulgular literatürle uyumluydu. Bir
hasta hariç tüm hastalar BIRADS grubuna göre düşük riskli gruptaydı.
Araştırmamızda biyopsi yapılan hastaların 2/3’ü ilk kez ultrasonografik takibe
giren hastalardı ve 1/3’ü şüpheli özelliklere sahipti. Literatürde belirtilen biyopsi endikasyonlarına göre hasta 40
yaşına gelmeden  ya da kitle ele gelmeden
yapılan bir ultrasonografik muayene ile lezyona ait referans bir döküman
bulunduğunda  fibroadenomlara yapılan
gereksiz biyopsi oranı azaltılabilir.

Anahtar Kelimeler

Fibroadenoma, Meme, Tru-cut Biyopsi, Ultrasonografi

Kaynakça

• 1. Houssami N, Cheung MN, Dixon JM. Fibroadenoma of the breast. Med J Aust. 2001;174:185-8.
• 2. Haagensen CD. Disease of the breast. 3rd ed. Philadelphia, Pa: W.B. Saunders; 1996. 267–83.
• 3. Rosai J. Breast, Chapter 20,Surgical Pathology ,Eighth Edition (ED:Rosai J) St. Louis :Mosby 1996,1565-60.
• 4. Prasad SN, Houserkova D. A comparison of mammography and ultrasonography in the evaluation of breast masses. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2007;151:315-22.
• 5. Brinton LA, Vajsey MP, Flavel R. Risk factors for benign breast disease. Am J Epidemiol. 1981;113:203–14.
• 6. Yu H, Rohan TE, Cook MG, Howe GR. Risk factor for fibroadenoma: a case control study in Australia. Am J Epidemiol. 1992;135:247–58.
• 7. Funder Burk WW, Rosero E, Leffall LD. Breast lesions in blacks. Surg Gynecol Obstet. 1972;135:58–61.
• 8. Soini I, Aine R, Lauslthti K. Independent risk factor of benign and malignant breast lesion. Am J Epidemiol. 1981;114:507–14.
• 9. Ravnihar B, Segel DG, Lindther J. An epidemiologic study of breast cancer and benign breast neoplasm in relation to the oral contraceptive and estrogen use. Eur J Cancer. 1979;15:395–405.
• 10. Canny PF, Berkowitz GS, Kelsey JL. Fibroadenoma and the use of exogenous hormones: a case control study. Am J Epidemiol. 1988;127:454–61.
• 11. Dupont WD, Page DL, Park FF. Long-term risk for breast cancer in women with fibroadenoma. N Engl J Med. 1994;331:10–5.
• 12. Parazzini F, La Vecchia C, Franceshi S. Risk factors for pathologically confirmed benign breast disease. Am J Epidemiol. 1984;120:115–22.
• 13. Schuerch C, Rosen PP, Hirota T, et al. A pathologic study of benign breast diseases in Tokyo and New York. Cancer.1982;50:1899–903.
• 14. Amin AL, Purdy AC, Mattingly JD, Kong AL, Termuhlen PM. Benign breast disease. Surg Clin North Am. 2003;93(2): 299-308.
• 15. Rosen PP (ed.) Rosen’s breast pathology, 2nd edn. Philadelphia, PA: Lippincott Williams & Wilkins, 2001.
• 16. Dixon JM, Dobie V, Lamb J, Walsh JS, Chetty U. Assessment of the acceptability of conservative management of fibroadenoma of the breast. Br J Surg 1996;83:264–5.
• 17. Fornage BD, Lorigan JG, Andry E: Fibroadenoma of the breast: sonographic appearance. Radiology 1989;172:671–5.
• 18. D’Orsi CJ, Sickles EA, Mendelson EB, Morris EA: ACR BI-RADS® Atlas, Breast Imaging Reporting and Data System, ed 5. Reston, American College of Radiology, 2013.
• 19. Namazi A, Adibi A, Haghighi A, Hashemi M. An Evaluation of Ultrasound Features of Breast Fibroadenoma. Adv Biomed Res 2017;6:153.
• 20. Nishimura S, Matsusue S, Koizumi S, Kashihara S. Size of breast cancer on ultrasonography, cut-surface of resected specimen, and palpation. Ultrasound Med Biol. 1988; 14(suppl 1):139-42.
• 21. Cole-Beuglet C, Soriano RZ, Kurtz AB, Goldberg BB. Fibroadenoma of the breast: sonomammography correlated with pathology in 122 patients. AJR 1983;140(2):369-75.
• 22. Heywang SH, Lipsit ER, Glassman UM, Thomas MA. Specificity of ultrasonography in the diagnosis of benign breast masses. J Ultrasound Med. 1984;3:453-61.
• 23. Jackson VP, Rothschild PA, Kreipke DL, Mail JT, Holden RW. The spectrum of sonographic findings of fibroadenoma of the breast. Invest Radiol. 1986;21:34-40.
• 24. Powell DE, Stelling CB. Diagnosis and detection of breast diseases. St Louis, Mo: MosbyYear Book, 1992; 159-61.
• 25. Rosen PP. Breast pathology. Philadelphia, Pa: Lippincott-Raven, 1997; 143-75.
• 26. Lanyi M. Diagnosis and differential diagnosis of breast calcifications. New York, NY: Springer-Verlag, 1988; 145-56.
• 27. Sirous M, Shahnani PS, Sirous A. Investigation of Frequency Distribution of Breast Imaging Reporting and Data System (BIRADS) Classification and Epidemiological Factors Related to Breast Cancer in Iran: A 7-year Study (2010-2016). Adv Biomed Res. 2018;27;7:56.
• 28. Margaret ME, Chester HF, Stephen BE, Cathleen AC, Martin CM. BI-RADS Classification for Management of Abnormal Mammograms. FAAFP J Am Board Fam Med. 2006;19(2):161-4.
• 29. Malur S, Wurdinger S, Moritz A, Michels W, Schneider A. Comparison of written reports of mammography, sonography and magnetic resonance mammography for preoperative evaluation of breast lesions, with special emphasis on magnetic resonance mammography. Breast Cancer Res. 2001;3:55-60.
• 30. Devolli-Disha E, Manxhuka-Kërliu S, Ymeri H, Kutllovci A. Comparative accuracy of mammography and ultrasound in women with breast symptoms according to age and breast density. Bosn J Basic Med Sci. 2009;9:131-6.