Fibroadenomas are benign tumors of the breast found in about 10% of women. They are more common among young women, especially between the ages of 15-30. Growth of fibroadenomas is accelerated in reproductive ages and during pregnancies due to estrogen effect. On physical examination, fibroadenomas are felt as mobile and hard masses. They can be single or multiple, their diameters are usually below 3 cm, but sometimes fibroadenomas that can reach giant dimensions can also be seen.
Some fibroadenomas do not grow and their ultrasound appearances are very typical. This type of fibroadenomas may be followed up with ultrasound only. However, if the masses grow or if their ultrasound findings are suspicious, a needle biopsy should be performed to confirm the diagnosis. If the fibroadenomas are large, if they grow in the follow-up, are painful or disturb the patient, they are usually treated. In some cases, patients may also prefer to be treated rather than being followed up for years.
What are the treatment methods?
Classical treatment of fibroadenomas is the removal of the mass by the operation (lumpectomy). However, surgery is not preferred by most patients due to the following limitations:
1. Surgical operation may requires an incision in the breast that disturbs the breast aesthetics.
2. Depending on the number and size of the fibroadenomas operated, the breast may be depressed and deformed.
3. The scar tissue created by the operation wound can cause confusing views mimicking cancer on mammography and ultrasound.
4. In patients with a large number of fibroadenomas, these risks increase exponentially, therefore surgical treatment is not an acceptable option in such cases.
Non-surgical treatment methods:
Breast fibroadenomas can be easily treated by non-surgical methods. These methods can be divided into two groups:
1. Methods that take out fibroadenomas without surgery (Vacuum biopsy system, BLES)
a. Vacuum biopsy system: This method was originally developed to take larger samples from the breast masses but it was also used for treatment. In the vacuum biopsy system, a 3-4mm needle is inserted into the mass through the skin under ultrasound guidance. When the device is operated, the cutters in the needle pull the tissue (vacuum) and continuously cutit into strips. These strips are collected through a thin hose in an external chamber. The needle is withdrawn and the procedure is terminated when it is seen on ultrasound that all the mass is removed. With a vacuum biopsy system, a 3-4 cm diameter typical fibroadenoma can be completely treated within 15 minutes.
b. BLES method: Breast Lesion Excision System (BLES) is a new form of treatment that has become widespread in the world for the last 10 years. In the BLES needle, there are special wires that burn the tissue with radiofrequency energy. When the needle is placed on the edge of the mass under ultrasound guidance and the device is operated, these wires come out of the needle and cut the tissue around the fibroadenoma and grasp the fibroadenoma like a scoop. The fibroadenoma, separated from the surrounding tissue, is then taken out through a small incision in one piece, as in classical surgery.
2. Methods of shrinking fibroadenomas in the breast without taking them out (Cryoablation, HIFU)
a. Cryoablation: Cryoablation has been successfully used in many types of cancer, especially in the prostate and kidney tumors. It is the only method that kills tumors in our body by freezing them. Cryoablation was also successfully applied to breast fibroadenomas and was already approved by the American Food and Drug Administration (FDA) for the treatment of fibroadenomas in 2002. In cryoablation, a thin needle is inserted into the fibroadenoma without incision in the skin and the mass is frozen between -20 to -140 degrees. The fibroadenoma mass, which loses its vitality by freezing, gradually becomes smaller in months. Studies have shown that after cryoablation, 90% of the fibroadenomas shrunk so that they can not be felt on manual examination.
b. HIFU (Hayfu): High Intensity Focused Ultrasound (HIFU) is a method that focuses the external ultrasound waves through a special lens and send them to the target in our body. These focused waves produce heat that warms the tissues and can kill tumors. In recent years, this method has been used in the treatment of breast fibroadenomas and thyroid nodules and successful results have been obtained. After HIFU treatment, as in cryoablation, fibroadenomas gradually shrink and disappear after a months.
Which method is more suitable?
All of these methods used in the treatment of fibroadenomas are performed under local anesthesia, they are painless, they do not require hospitalization and do not disrupt breast aesthetics. Nevertheless, each treatment method has its own advantages and disadvantages which should be taken into account when selecting the most appropriate method. In addition to the advantages and limitations of each method, the interventional oncologist who will perform the procedure should also consider the number and size of tumors, their distance to the skin, the structure of the breast and the expectations of the patient.
Interventional oncology in cancer management
Prof Saim Yilmaz, MD