Abstract

Introduction Best practice guidelines suggest that patients < 25 years with ultrasound diagnosis of fibroadenoma, biopsy can be avoided if certain radiological criteria are satisfied. There is a cohort of patients < 35 years with ultrasound features suggestive of fibroadenoma who are being exposed to unnecessary biopsies. The aim of this study is to determine how many patients with ultrasound features of fibroadenoma have had normal histology and therefore could potentially avoid a biopsy. Methods Records of women presenting to East Lancashire NHS Trust Breast Unit between 2013 and 2015 were obtained. Only patients between 25 and 35 years at the age of presentation, with clinical benign breast lump and an USS diagnosis of fibroadenoma were included. Corresponding Fine Needle Aspiration (FNA) cytology was noted. Cost of FNA and specimen preparation was recorded. Results A total of 135 USS diagnosis of fibroadenomas were reviewed, of which there were 121 patients with a mean age of 28.9 years. 100/135 (74.1%) of fibroadenomas were subjected to FNA, of which 75/135 (55.6%) revealed cytology of C2, 22/135 (16.3%) were C1. Only 1/135 (0.7%) fibroadenoma was C3, which on subsequent core-biopsy was B2. There was 35/135 (25.9%) fibroadenomas that were not subjected to FNA with a median age was 25 years. Equipment for FNA cost £0.73 and cytology was £90 for each specimen processed (total £9073). Conclusion This study has demonstrated that it is safe to increase the age of patients with presumed fibroadenoma from 25 to 35 years without the need to confirm the diagnosis with FNA. In our study, no cancers would have been missed in this age group providing strict sonographic and clinical criteria are used.

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