Users Online: 2361
Home Print this page Email this page
Home About us Editorial board Search Browse articles Submit article Ahead of Print Instructions Subscribe Contacts Login 


 
Previous article Browse articles Next article 
BRIEF REPORT
Adv Biomed Res 2017,  6:153

An Evaluation of Ultrasound Features of Breast Fibroadenoma


Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran

Date of Web Publication30-Nov-2017

Correspondence Address:
Prof. Atoosa Adibi
Department of Radiology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan
Iran
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2277-9175.219418

Rights and Permissions
  Abstract 

Background: Breast cancer is among the most common cancers in the world. Ultrasound evaluations of breast have come into attention as an alternative route. Ultrasound features of benign lesions such as fibroadenoma can be overlapping with those in a malignant tumor. Here, we assessed the reports of breast ultrasound in patients with pathologic diagnosis of fibroadenoma. Materials and Methods: We conducted a cross-sectional study and enrolled female patients with confirmed histologic diagnosis of fibroadenoma. Ultrasound studies were performed on the participants to see which sonographic patterns are more frequent in such lesions. Results: In 92 patients with 40.4 ± 9.2 years of age, all participants were classified as stage 4 on Breast Imaging-Reporting and Data System scale. The mean ± standard deviation of size for the lesions was 167.4 ± 101.4 mm2. Upper outer quadrants in the breasts had the most number of lesions. Almost lesions were round with only 2.2% were oval. When assessed for the margin definition, 57.8% were circumscribed. Noncircumscribed masses were reported in 21.7%. About 91.3% of cases were hypoechoic in the ultrasound evaluation. Lobulated masses were in 28.3% of the cases. 8.7% of the masses were spongy whereas 9.8% and 2.2% of them had calcification and heterogenic appearance, respectively. Conclusion: The most frequent features include a hypoechoic mass with a circumscribed border; however, complex presentations that overlap malignant masses are also detectable including noncircumscribed margin, lobulation, presence of a posterior shadow, heterogenicity, and micro calcification.

Keywords: Breast, fibroadenoma, ultrasonogram


How to cite this article:
Namazi A, Adibi A, Haghighi M, Hashemi M. An Evaluation of Ultrasound Features of Breast Fibroadenoma. Adv Biomed Res 2017;6:153

How to cite this URL:
Namazi A, Adibi A, Haghighi M, Hashemi M. An Evaluation of Ultrasound Features of Breast Fibroadenoma. Adv Biomed Res [serial online] 2017 [cited 2020 Feb 19];6:153. Available from: http://www.advbiores.net/text.asp?2017/6/1/153/219418


  Introduction Top


Breast masses are classified as either malignant tumors or benign growths and masses. Assessment of pathology is the golden standard in diagnosing a breast mass; however, other less invasive evaluations are also available that save the time and resources for both the patient and the health systems. The use of routine physical examinations and imaging studies are powerful descriptive tools to narrow down the number of patients who undergo pathologic sampling;[1],[2],[3] therefore, it is imperative to define the expected findings in these studies for different mass types so that enough sensitivity can be achieved for these methods to be a proper alternative for the screening and pathologic assessments in breast masses.[1],[4]

Malignant tumors are uncommon among younger women.[5] Fibroadenoma is a form of benign breast mass. It consists of both stromal and epithelial elements.[6] They are more prevalent in younger patients and incidence drops with aging. Fibroadenoma as a benign breast mass has been found to increase the risk of breast cancer when compared to healthy individuals within the same age groups. Imaging studies are often used for early detection and evaluation of these masses.

Mammograms are limited to differentiate fibroadenoma masses from other pathologies, i.e., cysts and carcinomas, as the quality of mammogram decreases in younger patients with denser breast tissues. Ultrasound is a useful alternative for mammographic studies. Cysts and carcinomas are better distinguished from fibroadenoma by ultrasound imaging; however, overlapping findings in nonhomogeneous fibroadenomas along with occasional calcification and noncircumscribed margins may mimic the findings in several other types of breast masses.[7] Here, we described the ultrasonographic findings of a group of patients whose fibroadenomas were previously established through pathologic assessments. We aimed to describe less common findings in a case of breast fibroadenoma.


  Materials and Methods Top


We conducted a cross-sectional study from 2011 to 2012 in Isfahan, Iran. We consecutively enrolled the referred female patients who had undergone tissue sampling of their breast masses; either it was because of suspicious palpable mass or imaging findings that suggested pathologic examinations. Only the patients whose pathologic diagnosis were positive for fibroadenoma of breast were included and other pathological reports or women who did not have an appropriate pathologic report of their mass, due to either insufficient tissue sample or discordance were excluded. Informed consents were taken from enrolled participants.

The data collected from the participants included their age, the confirmed pathologic report of each patient's breast mass as fibroadenoma, and also ultrasound reports. All ultrasound studies were performed by GE Voluson Pro 730 (United States), ultrasonographic equipment with 7.5–10 MHz probes by a skilled radiologist. All reports had to have the site, size, and appearance of the mass. The overall shape of the mass, margin definition, and its content features were reported in all cases. We also registered the category of the masses based on the established Breast Imaging-Reporting and Data System (BIRADS) scale through ultrasound imaging.[8]

Statistical analysis of the collected data was performed using the SPSS software, version 20, (Chicago, IL, USA). We used descriptive measures to represent the categorical data. ANOVA test was used to compare the means. P < 0.05 was considered statistically significant.


  Results Top


In the present study, 92 patients were enrolled. The mean ± standard deviation (SD) of age was 40.4 ± 9.2 years. The mean ± SD for size of the fibroadenomas was 167.4 ± 101.4 mm 2. Average size of fibroadenoma masses was compared between patients and across all four quadrants of both breasts. No significant difference was detected (P > 0.05). Data are presented in [Table 1].
Table 1: Comparison of the mean size of breast masses between the four quadrants

Click here to view


When assessed for the BIRADS categorization, 88% of the masses were concerned as 4a class. 8.7% and 3.3% of the masses were categorized as 4b and 4c, respectively.

The distribution and frequency of fibroadenoma in different areas of each breast are presented in [Figure 1]. The most frequent site for fibroadenoma was the upper outer lobe of each breast. About 64.4% and 57.4% of the masses were located in the upper outer quadrant of the left and right breast, respectively.
Figure 1: The frequency of the masses, based on their placements on a clock-like grid

Click here to view


The ultrasound features of fibroadenomas in all enrolled patients were gathered and reported in [Figure 2], across three main categories. Regarding the shape of the masses, almost all the masses were round with only 2.2% reported oval. When assessed for the margin definition, 57.8% were reported circumscribed. Noncircumscribed masses were reported in 21.7% of the cases. 18.2% of the cases were reported with noncircumscribed margins among all the cases with 4b or 4c BIRADS categorization. Content evaluation of the masses revealed that 91.3% of cases were hypoechoic in the ultrasound evaluation. Lobulated masses were reported in 28.3% of the cases. 8.7% of the masses were spongy whereas 9.8% and 2.2% of them had calcification and heterogenic appearance, respectively.
Figure 2: The frequency of the different features of fibroadenoma masses, when assessed by ultrasound

Click here to view



  Discussion Top


Breast masses, as one of the most common indicators of probable breast cancers, particularly in female patients, are the subject of studies that try to define new measures of screening for a faster and safer detection of underlying etiology.[1],[2],[9] Here, we evaluated the ultrasound features of fibroadenoma to report the frequent findings of such masses.

It has been established in the literature that clinical diagnosis of fibroadenoma does not exclude malignancies.[6] Ultrasound imaging in young patients and its combination with mammogram in older patients provides further evidence for a more accurate diagnosis; however, there are reports of overlapping features in the results with other diagnosis.[1],[2]

As other benign lesions are seen in breast, fibroadenoma is usually seen as a round or oval mass with smooth margins and an either hypoechoic or isoechoic appearance. Although fibroadenoma is not a capsulated lesion, a thin layer of echogenicity surrounds it which is mainly due to the compressed normal breast tissue; any thickened echogenicity questions the diagnosis of fibroadenoma and could be suggestive of a potential malignant pathology.[10],[11]

Smith and Burrows declared in their study that there were no discrepancies of diagnosis between ultrasound and biopsy samples for fibroadenoma; therefore, it is not indicated to investigate all cases through biopsy unless there are added abnormalities in the physical examination or patients' history.[10],[11],[12] Less commonly reported ultrasound features of fibroadenoma include noncircumscribed margin, calcifications, lobulations, and posterior acoustic shadows.

Alarming signs and symptoms that are usually seen in the cases of malignant breast masses, although rarely, but have been reported in the course of a fibroadenoma. Liu et al. reported a case with unilateral palpable breast mass and bloody discharge from the nipple in a 12-year-old girl. The histological report revealed the mass to be a fibroadenoma with the infarction as the cause of hemorrhage.[13] In a similar case, Arora et al. reported of a 37-year-old female, with painful, slowly growing, and hemorrhagic unilateral breast mass that was diagnosed through pathologic sampling as a benign case of infarcted fibroadenoma.[14]

Age range of the patients has also been a subject of dispute in the literature. Although young females are the most common cases of fibroadenoma, incidence is still expected well into the menopausal years. Shi et al. reported of fibroadenoma in a 16-month-old infant.[15] In all the mentioned cases, no regional lymphadenopathy or recurrence after follow-up was reported.

Although many cases of fibroadenoma are benign, factors such as older age, previous positive familial history for breast cancer, multiple lesions, micro calcifications, and heterogenicity should raise the suspicion of whether or not a lesion is a benign fibroadenoma or it needs further assessment for other diagnosis. The main reported differential diagnosis for such cases includes complicated cyst, cystosarcoma, fibromyxoid, phyllodes tumors, and breast malignancies.[16],[17],[18],[19],[20]

In our study, all of the 92 enrolled patients had benign pathologic results and were classified as different variants of category 4 on the BIRADS grading scale. This is supported by the literature that only a small fraction of the patients diagnosed with fibroadenoma may present with manifestations of a malignant tumor.

Regarding the size of the tumors, like it is seen in many of the breast malignancies as well, none of the four quadrants in a breast is predisposed to the development of bigger tumors; however, lesions were more frequently observed in the upper outer quadrant of the breasts as it is evident in [Figure 1]. It is indicated by both the literature and our results that the size of fibroadenoma rarely exceeds 3 cm.

Our results were consistent with the literature regarding the ultrasound features. The shape of the majority of the cases was round. Their margins were well-defined with circumscribed borders; yet a fraction of the cases presented noncircumscribed margins. Interestingly, prevalence of noncircumscribed masses did not increase when we excluded 4a BIRADS category. Most commonly, we found the cases to be hypoechoic. Consistent with the previous studies, there were very few abnormal findings in comparison to the entire assessed data.


  Conclusion Top


Ultrasound features of fibroadenoma include a range of different presentations that most frequently are consistent with presentations seen in a benign mass. The most frequent features include a round hypo echoic mass with a circumscribed borders; however, complex presentations that overlap with complex or malignant masses such as calcification and heterogenicity are also detectable. When classified by the BIRADS system, in a fraction of the cases, moderate suspicion to malignancy was reported. Regarding the retrospective manner of the study, we were not blind about the pathological results of study, so this is a limitation for this work. Further study with prospective design is recommended.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
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.  Back to cited text no. 1
[PUBMED]    
2.
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.  Back to cited text no. 2
    
3.
Borecky N, Rickard M. Preoperative diagnosis of carcinoma within fibroadenoma on screening mammograms. J Med Imaging Radiat Oncol 2008;52:64-7.  Back to cited text no. 3
[PUBMED]    
4.
Berg WA, Blume JD, Cormack JB, Mendelson EB, Lehrer D, Böhm-Vélez M, et al. Combined screening with ultrasound and mammography vs mammography alone in women at elevated risk of breast cancer. JAMA 2008;299:2151-63.  Back to cited text no. 4
    
5.
Pengelly S, Lambert AW, Khan M, Groome J. Breast lumps in service women. J R Nav Med Serv 2014;100:174-8.  Back to cited text no. 5
[PUBMED]    
6.
Houssami N, Cheung MN, Dixon JM. Fibroadenoma of the breast. Med J Aust 2001;174:185-8.  Back to cited text no. 6
[PUBMED]    
7.
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.  Back to cited text no. 7
[PUBMED]    
8.
Elverici E, Zengin B, Nurdan Barca A, Didem Yilmaz P, Alimli A, Araz L. Interobserver and intraobserver agreement of sonographic BIRADS lexicon in the assessment of breast masses. Iran J Radiol 2013;10:122-7.  Back to cited text no. 8
[PUBMED]    
9.
Rjosk-Dendorfer D, Reu S, Deak Z, Hetterich H, Kolben T, Reiser M, et al. High resolution compression elastography and color doppler sonography in characterization of breast fibroadenoma. Clin Hemorheol Microcirc 2014;58:115-25.  Back to cited text no. 9
[PUBMED]    
10.
Fornage BD, Lorigan JG, Andry E. Fibroadenoma of the breast: Sonographic appearance. Radiology 1989;172:671-5.  Back to cited text no. 10
[PUBMED]    
11.
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.  Back to cited text no. 11
[PUBMED]    
12.
Smith GE, Burrows P. Ultrasound diagnosis of fibroadenoma – Is biopsy always necessary? Clin Radiol 2008;63:511-5.  Back to cited text no. 12
[PUBMED]    
13.
Liu H, Yeh ML, Lin KJ, Huang CK, Hung CM, Chen YS. Bloody nipple discharge in an adolescent girl: Unusual presentation of juvenile fibroadenoma. Pediatr Neonatol 2010;51:190-2.  Back to cited text no. 13
[PUBMED]    
14.
Arora R, Abou-Bakr A, Al Taleb A. Fine needle aspiration diagnosis of a spontaneously infarcted fibroadenoma mimicking carcinoma: A case report. Anal Quant Cytopathol Histpathol 2013;35:57-60.  Back to cited text no. 14
[PUBMED]    
15.
Shi A, Li S, Xu N, Nie G, Li X, Zhang T, et al. Clinical features and prognosis of a unilateral fibroadenoma of the breast in a 16-month-old female. Jpn J Clin Oncol 2011;41:260-4.  Back to cited text no. 15
[PUBMED]    
16.
Wirtzfeld LA, Nam K, Labyed Y, Ghoshal G, Haak A, Sen-Gupta E, et al. Techniques and evaluation from a cross-platform imaging comparison of quantitative ultrasound parameters in an in vivo rodent fibroadenoma model. IEEE Trans Ultrason Ferroelectr Freq Control 2013;60:1386-400.  Back to cited text no. 16
[PUBMED]    
17.
Limite G, Esposito E, Sollazzo V, Ciancia G, Formisano C, Di Micco R, et al. Lobular intraepithelial neoplasia arising within breast fibroadenoma. BMC Res Notes 2013;6:267.  Back to cited text no. 17
[PUBMED]    
18.
Zaitsev AN, Vesnin AG, Semiglazov VF, Orlov AA, Chernomordikova MF, Chebykin IA, et al. Ultrasound differentiation of fibroadenoma and diagnosis of minimal carcinoma of the breast. Vopr Onkol 1998;44:198-202.  Back to cited text no. 18
    
19.
Asirvatham JR, Shah A, Carreon CK, Bhuiya TA, Kahn LB, Kostroff K, et al. Ossifying fibromyxoid tumor of the breast mimicking fibroadenoma: A case report and differential diagnoses. Arch Pathol Lab Med 2014;138:1098-100.  Back to cited text no. 19
[PUBMED]    
20.
Gatta G, Iaselli F, Parlato V, Di Grezia G, Grassi R, Rotondo A. Differential diagnosis between fibroadenoma, giant fibroadenoma and phyllodes tumour: Sonographic features and core needle biopsy. Radiol Med 2011;116:905-18.  Back to cited text no. 20
[PUBMED]    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1]


This article has been cited by
1 Breast Lesions in Women Aged Younger than 30 Years: Clinical Presentation, Diagnosis, and Management
Haley R Clark,Kanwal A Merchant,Lena A Omar,Lindsay M Compton,Jody C Hayes
Journal of Breast Imaging. 2020;
[Pubmed] | [DOI]
2 Spindle cell lesions of the breast: diagnostic issues
Joshua JX. Li,Gary M. Tse
Diagnostic Histopathology. 2019;
[Pubmed] | [DOI]



 

Top
Previous article  Next article
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed2018    
    Printed39    
    Emailed0    
    PDF Downloaded215    
    Comments [Add]    
    Cited by others 2    

Recommend this journal