Is it safe practice not to biopsy fibroadenomas in women under 30?

Abstract

Introduction Fibroadenomas (FAs) present as common breast lesions in young women, often necessitating core biopsy/fine needle aspiration. Our unit protocol has been to biopsy suspected FAs in women aged 20 years and over. Literature suggests there is a case for safe non-biopsy in the under 25s. We wanted to establish whether it would be safe practice to stop biopsying FAs in women <30 years of age. Methods A theoretical incidence of a benign presentation of breast cancer in our unit was established using national statistics and Stavros criteria [1]. Using this, an imaging criteria-based protocol for nonbiopsy of FAs was devised, which we retrospectively tested against our departmental practice over the period 2000 to 2008 in women <30 years of age. Results Between 2000 and 2008, 9 cancers were diagnosed in this age group and 490 fibroepithelial lesions were core biopsied, resulting in 479 histologically B2 FAs and 11 B3 lesions. Of the 11 B3 lesions, subsequent surgical histology downgraded 9 to FAs, the remaining 2 being phyllodes tumours. Case review of both the phyllodes and the cancers, applying retrospective non-biopsy criteria, demonstrated that none of these lesions (B3 and above) would have been missed. Conclusion Our new protocol provides a sound evidence base for non-biopsy of FAs in women <30 years of age. This is safe practice provided there is rigid adherence to the protocol and this is currently being audited.