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KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
TERMINOLOGY
Abbreviations
- Fibroadenoma (FA)
Synonyms
- Degenerating FA = sclerosed FA = involuting FA
Definitions
- FA: Benign, fibroepithelial tumor with proliferation of both stromal and epithelial elements
- Fibroepithelial lesions (FEL): Biphasic tumor, encompassing FA and phyllodes tumors (PTs)
- PT differs subtly from FA: ↑ cellularity of stroma, including mitotic figures, stromal overgrowth (stromal > epithelial component); leaf-like growth pattern; age ≥ 40 years; rapid growth; propensity for local recurrence
- Difficult to distinguish on core biopsy histopathology and sometimes even excision
- Major FA types: Adult and juvenile ("cellular") types
- Complex FA: Cysts > 3 mm ± extensive sclerosing adenosis, fibrocystic change &/or hyperplasia, papillary apocrine metaplasia
- Often < FA, ~ 1.2 cm or less
- Giant FA: > 500 g or > 5-cm mass that has proliferation of epithelial and connective tissue; typically circumscribed and firm with peak age of 17-20 years
- Sclerosed FA: Paucicellular, hyalinized, fibrotic stroma and sparse, atrophic epithelial elements
- Natural history of FA to become sclerosed and calcify
- Can occur at any age; tend to be postmenopausal
- Myxoid FA: Mucinous stromal component
- Fibroadenomatoid change: Composite features of FA and fibrocystic change, stromal hyperplasia predominating but less discrete than FA and may involve several lobules
IMAGING
General Features
Mammographic Findings
Ultrasonographic Findings
Imaging Recommendations
MR Findings
Nuclear Medicine Findings
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Selected References
- Abdul Hamid S et al: Radiopathological characteristics and outcomes of phyllodes tumor of the breast in Malaysian women. Medicine (Baltimore). 97(31):e11412, 2018
- Ciurea AI et al: Fibroadenomas and breast carcinoma: a possible answer to a frequently asked question. A pictorial essay. Med Ultrason. 20(3):385-91, 2018
- Dessauvagie BF et al: Interobserver variation in the diagnosis of fibroepithelial lesions of the breast: a multicentre audit by digital pathology. J Clin Pathol. ePub, 2018
- Ha SM et al: Growing BI-RADS category 3 lesions on follow-up breast ultrasound: malignancy rates and worrisome features. Br J Radiol. 91(1087):20170787, 2018
- Jung J et al: Development of a management algorithm for the diagnosis of cellular fibroepithelial lesions from core needle biopsies. Int J Surg Pathol. 1066896918775525, 2018
- Lee SE et al: Radiomics of US texture features in differential diagnosis between triple-negative breast cancer and fibroadenoma. Sci Rep. 8(1):13546, 2018
- Lee S et al: Frequency and outcomes of biopsy-proven fibroadenomas recommended for surgical excision. Clin Imaging. 50:31-36, 2018
- Neville G et al: Is excision biopsy of fibroadenomas based solely on size criteria warranted? Breast J. ePub, 2018
- Rao R et al: Select choices in benign breast disease: an initiative of the American Society of Breast Surgeons for the American Board of Internal Medicine Choosing Wisely® Campaign. Ann Surg Oncol. ePub, 2018
- Shaik AN et al: Breast fibroadenomas are not associated with increased breast cancer risk in an African American contemporary cohort of women with benign breast disease. Breast Cancer Res. 20(1):91, 2018
- Yeo SH et al: Comparison of ultrasound elastography and color doppler ultrasonography for distinguishing small triple-negative breast cancer from fibroadenoma. J Ultrasound Med. ePub, 2018
- Clauser P et al: Results of short-term follow-up in BI-RADS 3 and 4a breast lesions with a histological diagnosis of fibroadenoma at percutaneous needle biopsy. Breast Care (Basel). 12(4):238-242, 2017
- Kupsik M et al: Giant juvenile fibroadenoma in a 9-year-old: a case presentation and review of the current literature. Breast Dis. 37(2):95-98, 2017
- Wahab TA et al: Efficacy and safety of ultrasound guided vacuum-assisted excision of fibroadenomas: a systematic review. Open J Radiol 7:95-102, 2017
- Loke BN et al: Genetics and genomics of breast fibroadenomas. J Clin Pathol. ePub, 2017
- Marcon M et al: First ultrasound diagnosis of BI-RADS 3 lesions in young patients: can 6-months follow-up be sufficient to assess stability? Eur J Radiol. 89:226-233, 2017
- Namazi A et al: An evaluation of ultrasound features of breast fibroadenoma. Adv Biomed Res. 6:153, 2017
- Duman L et al: Differentiation between phyllodes tumors and fibroadenomas based on mammographic sonographic and MRI features. Breast Care (Basel). 11(2):123-7, 2016
- Edwards T et al: Cellular fibroadenoma on core needle biopsy: management recommendations for the radiologist. Clin Imaging. 40(4):587-90, 2016
- Fives C et al: When pathological and radiological correlation is achieved, excision of fibroadenoma with lobular neoplasia on core biopsy is not warranted. Breast. 30:125-129, 2016
- Harvey JA et al: ACR appropriateness criteria palpable breast masses. J Am Coll Radiol. 13(11S):e31-e42, 2016
- Marcil G et al: Fibroepithelial breast lesions diagnosed by core needle biopsy demonstrate a moderate rate of upstaging to phyllodes tumors. Am J Surg. ePub, 2016
- Parsian S et al: Diffusion-weighted imaging reflects variable cellularity and stromal density present in breast fibroadenomas. Clin Imaging. 40(5):1047-54, 2016
- Hubbard JL et al: Criteria for excision of suspected fibroadenomas of the breast. Am J Surg. 209(2):297-301, 2015
- Nassar A et al: Complex fibroadenoma and breast cancer risk: a Mayo Clinic Benign Breast Disease Cohort Study. Breast Cancer Res Treat. 153(2):397-405, 2015
- Plaza MJ et al: Phyllodes tumor: review of key imaging characteristics. Breast Dis. 35(2):79-86, 2015
- Sanders LM et al: The growing fibroadenoma. Acta Radiol Open. 4(4):2047981615572273, 2015
- Abdulcadir D et al: Phyllodes tumours of the breast diagnosed as B3 category on image-guided 14-gauge core biopsy: analysis of 51 cases from a single institution and review of the literature. Eur J Surg Oncol. 40(7):859-64, 2014
- Yang X et al: Fibroepithelial tumors of the breast: pathologic and immunohistochemical features and molecular mechanisms. Arch Pathol Lab Med. 138(1):25-36, 2014
- Adejolu M et al: False-positive lesions mimicking breast cancer on FDG PET and PET/CT. AJR Am J Roentgenol. 198(3):W304-14, 2012
- Berg WA et al: Shear-wave elastography improves the specificity of breast US: the BE1 multinational study of 939 masses. Radiology. 262(2):435-49, 2012
- Chang JM et al: Clinical application of shear wave elastography (SWE) in the diagnosis of benign and malignant breast diseases. Breast Cancer Res Treat. 129(1):89-97, 2011
- Gupta P et al: Fibroadenoma in male breast: case report and literature review. Breast Dis. 33(1):45-8, 2011
- Kato F et al: Dynamic MR findings of ductal carcinoma in situ within a fibroadenoma. Magn Reson Med Sci. 10(2):129-32, 2011
- Makis W et al: Rapidly growing complex fibroadenoma with surrounding ductal hyperplasia mimics breast malignancy on serial F-18 FDG PET/CT imaging. Clin Nucl Med. 36(7):576-9, 2011
- Narayanan D et al: Interpretation of positron emission mammography: feature analysis and rates of malignancy. AJR Am J Roentgenol. 196(4):956-70, 2011
- Slanetz PJ et al: Percutaneous excision: a viable alternative to manage benign breast lesions. Can Assoc Radiol J. 62(4):265-71, 2011
- Resetkova E et al: Clinical and radiologic data and core needle biopsy findings should dictate management of cellular fibroepithelial tumors of the breast. Breast J. 16(6):573-80, 2010
- Sanchez R et al: Breast fibroadenomas in the pediatric population: common and uncommon sonographic findings. Pediatr Radiol. 40(10):1681-9, 2010
- Harvey JA et al: Short-term follow-up of palpable breast lesions with benign imaging features: evaluation of 375 lesions in 320 women. AJR Am J Roentgenol. 193(6):1723-30, 2009
- Partridge SC et al: Quantitative diffusion-weighted imaging as an adjunct to conventional breast MRI for improved positive predictive value. AJR Am J Roentgenol. 193(6):1716-22, 2009
- Park YM et al: Palpable breast masses with probably benign morphology at sonography: can biopsy be deferred? Acta Radiol. 49(10):1104-11, 2008
- Schrading S et al: Mammographic, US, and MR imaging phenotypes of familial breast cancer. Radiology. 246(1):58-70, 2008
- Sklair-Levy M et al: Incidence and management of complex fibroadenomas. AJR Am J Roentgenol. 190(1):214-8, 2008
- Bode MK et al: Ultrasonography and core needle biopsy in the differential diagnosis of fibroadenoma and tumor phyllodes. Acta Radiol. 48(7):708-13, 2007
- Doshi DJ et al: Complex cystic breast masses: diagnostic approach and imaging-pathologic correlation. Radiographics. 27 Suppl 1:S53-64, 2007
- Binokay F et al: Risk of developing fibroadenoma with the use of cyclosporine A in renal transplant recipients. Ren Fail. 27(6):721-5, 2005
- Nurko J et al: Interim results from the FibroAdenoma Cryoablation Treatment Registry. Am J Surg. 190(4):647-51; discussion 651-2, 2005
- Graf O et al: Follow-up of palpable circumscribed noncalcified solid breast masses at mammography and US: can biopsy be averted? Radiology. 233(3):850-6, 2004
- Strano S et al: Color Doppler imaging of fibroadenomas of the breast with histopathologic correlation. J Clin Ultrasound. 32(7):317-22, 2004
- El-Wakeel H et al: Systematic review of fibroadenoma as a risk factor for breast cancer. Breast. 12(5):302-7, 2003
- Gordon PB et al: Solid breast masses diagnosed as fibroadenoma at fine-needle aspiration biopsy: acceptable rates of growth at long-term follow-up. Radiology. 229(1):233-8, 2003
- Sperber F et al: Diagnosis and treatment of breast fibroadenomas by ultrasound-guided vacuum-assisted biopsy. Arch Surg. 138(7):796-800, 2003
- Carter BA et al: No elevation in long-term breast carcinoma risk for women with fibroadenomas that contain atypical hyperplasia. Cancer. 92(1):30-6, 2001
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
TERMINOLOGY
Abbreviations
- Fibroadenoma (FA)
Synonyms
- Degenerating FA = sclerosed FA = involuting FA
Definitions
- FA: Benign, fibroepithelial tumor with proliferation of both stromal and epithelial elements
- Fibroepithelial lesions (FEL): Biphasic tumor, encompassing FA and phyllodes tumors (PTs)
- PT differs subtly from FA: ↑ cellularity of stroma, including mitotic figures, stromal overgrowth (stromal > epithelial component); leaf-like growth pattern; age ≥ 40 years; rapid growth; propensity for local recurrence
- Difficult to distinguish on core biopsy histopathology and sometimes even excision
- Major FA types: Adult and juvenile ("cellular") types
- Complex FA: Cysts > 3 mm ± extensive sclerosing adenosis, fibrocystic change &/or hyperplasia, papillary apocrine metaplasia
- Often < FA, ~ 1.2 cm or less
- Giant FA: > 500 g or > 5-cm mass that has proliferation of epithelial and connective tissue; typically circumscribed and firm with peak age of 17-20 years
- Sclerosed FA: Paucicellular, hyalinized, fibrotic stroma and sparse, atrophic epithelial elements
- Natural history of FA to become sclerosed and calcify
- Can occur at any age; tend to be postmenopausal
- Myxoid FA: Mucinous stromal component
- Fibroadenomatoid change: Composite features of FA and fibrocystic change, stromal hyperplasia predominating but less discrete than FA and may involve several lobules
IMAGING
General Features
Mammographic Findings
Ultrasonographic Findings
Imaging Recommendations
MR Findings
Nuclear Medicine Findings
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Selected References
- Abdul Hamid S et al: Radiopathological characteristics and outcomes of phyllodes tumor of the breast in Malaysian women. Medicine (Baltimore). 97(31):e11412, 2018
- Ciurea AI et al: Fibroadenomas and breast carcinoma: a possible answer to a frequently asked question. A pictorial essay. Med Ultrason. 20(3):385-91, 2018
- Dessauvagie BF et al: Interobserver variation in the diagnosis of fibroepithelial lesions of the breast: a multicentre audit by digital pathology. J Clin Pathol. ePub, 2018
- Ha SM et al: Growing BI-RADS category 3 lesions on follow-up breast ultrasound: malignancy rates and worrisome features. Br J Radiol. 91(1087):20170787, 2018
- Jung J et al: Development of a management algorithm for the diagnosis of cellular fibroepithelial lesions from core needle biopsies. Int J Surg Pathol. 1066896918775525, 2018
- Lee SE et al: Radiomics of US texture features in differential diagnosis between triple-negative breast cancer and fibroadenoma. Sci Rep. 8(1):13546, 2018
- Lee S et al: Frequency and outcomes of biopsy-proven fibroadenomas recommended for surgical excision. Clin Imaging. 50:31-36, 2018
- Neville G et al: Is excision biopsy of fibroadenomas based solely on size criteria warranted? Breast J. ePub, 2018
- Rao R et al: Select choices in benign breast disease: an initiative of the American Society of Breast Surgeons for the American Board of Internal Medicine Choosing Wisely® Campaign. Ann Surg Oncol. ePub, 2018
- Shaik AN et al: Breast fibroadenomas are not associated with increased breast cancer risk in an African American contemporary cohort of women with benign breast disease. Breast Cancer Res. 20(1):91, 2018
- Yeo SH et al: Comparison of ultrasound elastography and color doppler ultrasonography for distinguishing small triple-negative breast cancer from fibroadenoma. J Ultrasound Med. ePub, 2018
- Clauser P et al: Results of short-term follow-up in BI-RADS 3 and 4a breast lesions with a histological diagnosis of fibroadenoma at percutaneous needle biopsy. Breast Care (Basel). 12(4):238-242, 2017
- Kupsik M et al: Giant juvenile fibroadenoma in a 9-year-old: a case presentation and review of the current literature. Breast Dis. 37(2):95-98, 2017
- Wahab TA et al: Efficacy and safety of ultrasound guided vacuum-assisted excision of fibroadenomas: a systematic review. Open J Radiol 7:95-102, 2017
- Loke BN et al: Genetics and genomics of breast fibroadenomas. J Clin Pathol. ePub, 2017
- Marcon M et al: First ultrasound diagnosis of BI-RADS 3 lesions in young patients: can 6-months follow-up be sufficient to assess stability? Eur J Radiol. 89:226-233, 2017
- Namazi A et al: An evaluation of ultrasound features of breast fibroadenoma. Adv Biomed Res. 6:153, 2017
- Duman L et al: Differentiation between phyllodes tumors and fibroadenomas based on mammographic sonographic and MRI features. Breast Care (Basel). 11(2):123-7, 2016
- Edwards T et al: Cellular fibroadenoma on core needle biopsy: management recommendations for the radiologist. Clin Imaging. 40(4):587-90, 2016
- Fives C et al: When pathological and radiological correlation is achieved, excision of fibroadenoma with lobular neoplasia on core biopsy is not warranted. Breast. 30:125-129, 2016
- Harvey JA et al: ACR appropriateness criteria palpable breast masses. J Am Coll Radiol. 13(11S):e31-e42, 2016
- Marcil G et al: Fibroepithelial breast lesions diagnosed by core needle biopsy demonstrate a moderate rate of upstaging to phyllodes tumors. Am J Surg. ePub, 2016
- Parsian S et al: Diffusion-weighted imaging reflects variable cellularity and stromal density present in breast fibroadenomas. Clin Imaging. 40(5):1047-54, 2016
- Hubbard JL et al: Criteria for excision of suspected fibroadenomas of the breast. Am J Surg. 209(2):297-301, 2015
- Nassar A et al: Complex fibroadenoma and breast cancer risk: a Mayo Clinic Benign Breast Disease Cohort Study. Breast Cancer Res Treat. 153(2):397-405, 2015
- Plaza MJ et al: Phyllodes tumor: review of key imaging characteristics. Breast Dis. 35(2):79-86, 2015
- Sanders LM et al: The growing fibroadenoma. Acta Radiol Open. 4(4):2047981615572273, 2015
- Abdulcadir D et al: Phyllodes tumours of the breast diagnosed as B3 category on image-guided 14-gauge core biopsy: analysis of 51 cases from a single institution and review of the literature. Eur J Surg Oncol. 40(7):859-64, 2014
- Yang X et al: Fibroepithelial tumors of the breast: pathologic and immunohistochemical features and molecular mechanisms. Arch Pathol Lab Med. 138(1):25-36, 2014
- Adejolu M et al: False-positive lesions mimicking breast cancer on FDG PET and PET/CT. AJR Am J Roentgenol. 198(3):W304-14, 2012
- Berg WA et al: Shear-wave elastography improves the specificity of breast US: the BE1 multinational study of 939 masses. Radiology. 262(2):435-49, 2012
- Chang JM et al: Clinical application of shear wave elastography (SWE) in the diagnosis of benign and malignant breast diseases. Breast Cancer Res Treat. 129(1):89-97, 2011
- Gupta P et al: Fibroadenoma in male breast: case report and literature review. Breast Dis. 33(1):45-8, 2011
- Kato F et al: Dynamic MR findings of ductal carcinoma in situ within a fibroadenoma. Magn Reson Med Sci. 10(2):129-32, 2011
- Makis W et al: Rapidly growing complex fibroadenoma with surrounding ductal hyperplasia mimics breast malignancy on serial F-18 FDG PET/CT imaging. Clin Nucl Med. 36(7):576-9, 2011
- Narayanan D et al: Interpretation of positron emission mammography: feature analysis and rates of malignancy. AJR Am J Roentgenol. 196(4):956-70, 2011
- Slanetz PJ et al: Percutaneous excision: a viable alternative to manage benign breast lesions. Can Assoc Radiol J. 62(4):265-71, 2011
- Resetkova E et al: Clinical and radiologic data and core needle biopsy findings should dictate management of cellular fibroepithelial tumors of the breast. Breast J. 16(6):573-80, 2010
- Sanchez R et al: Breast fibroadenomas in the pediatric population: common and uncommon sonographic findings. Pediatr Radiol. 40(10):1681-9, 2010
- Harvey JA et al: Short-term follow-up of palpable breast lesions with benign imaging features: evaluation of 375 lesions in 320 women. AJR Am J Roentgenol. 193(6):1723-30, 2009
- Partridge SC et al: Quantitative diffusion-weighted imaging as an adjunct to conventional breast MRI for improved positive predictive value. AJR Am J Roentgenol. 193(6):1716-22, 2009
- Park YM et al: Palpable breast masses with probably benign morphology at sonography: can biopsy be deferred? Acta Radiol. 49(10):1104-11, 2008
- Schrading S et al: Mammographic, US, and MR imaging phenotypes of familial breast cancer. Radiology. 246(1):58-70, 2008
- Sklair-Levy M et al: Incidence and management of complex fibroadenomas. AJR Am J Roentgenol. 190(1):214-8, 2008
- Bode MK et al: Ultrasonography and core needle biopsy in the differential diagnosis of fibroadenoma and tumor phyllodes. Acta Radiol. 48(7):708-13, 2007
- Doshi DJ et al: Complex cystic breast masses: diagnostic approach and imaging-pathologic correlation. Radiographics. 27 Suppl 1:S53-64, 2007
- Binokay F et al: Risk of developing fibroadenoma with the use of cyclosporine A in renal transplant recipients. Ren Fail. 27(6):721-5, 2005
- Nurko J et al: Interim results from the FibroAdenoma Cryoablation Treatment Registry. Am J Surg. 190(4):647-51; discussion 651-2, 2005
- Graf O et al: Follow-up of palpable circumscribed noncalcified solid breast masses at mammography and US: can biopsy be averted? Radiology. 233(3):850-6, 2004
- Strano S et al: Color Doppler imaging of fibroadenomas of the breast with histopathologic correlation. J Clin Ultrasound. 32(7):317-22, 2004
- El-Wakeel H et al: Systematic review of fibroadenoma as a risk factor for breast cancer. Breast. 12(5):302-7, 2003
- Gordon PB et al: Solid breast masses diagnosed as fibroadenoma at fine-needle aspiration biopsy: acceptable rates of growth at long-term follow-up. Radiology. 229(1):233-8, 2003
- Sperber F et al: Diagnosis and treatment of breast fibroadenomas by ultrasound-guided vacuum-assisted biopsy. Arch Surg. 138(7):796-800, 2003
- Carter BA et al: No elevation in long-term breast carcinoma risk for women with fibroadenomas that contain atypical hyperplasia. Cancer. 92(1):30-6, 2001
