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Fibroadenoma
Laurie Margolies, MD; Wendie A. Berg, MD, PhD, FACR, FSBI
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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

                                            1. Abdul Hamid S et al: Radiopathological characteristics and outcomes of phyllodes tumor of the breast in Malaysian women. Medicine (Baltimore). 97(31):e11412, 2018
                                            2. 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
                                            3. 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
                                            4. 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
                                            5. 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
                                            6. 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
                                            7. Lee S et al: Frequency and outcomes of biopsy-proven fibroadenomas recommended for surgical excision. Clin Imaging. 50:31-36, 2018
                                            8. Neville G et al: Is excision biopsy of fibroadenomas based solely on size criteria warranted? Breast J. ePub, 2018
                                            9. 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
                                            10. 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
                                            11. 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
                                            12. 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
                                            13. 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
                                            14. 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
                                            15. Loke BN et al: Genetics and genomics of breast fibroadenomas. J Clin Pathol. ePub, 2017
                                            16. 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
                                            17. Namazi A et al: An evaluation of ultrasound features of breast fibroadenoma. Adv Biomed Res. 6:153, 2017
                                            18. 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
                                            19. Edwards T et al: Cellular fibroadenoma on core needle biopsy: management recommendations for the radiologist. Clin Imaging. 40(4):587-90, 2016
                                            20. 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
                                            21. Harvey JA et al: ACR appropriateness criteria palpable breast masses. J Am Coll Radiol. 13(11S):e31-e42, 2016
                                            22. 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
                                            23. Parsian S et al: Diffusion-weighted imaging reflects variable cellularity and stromal density present in breast fibroadenomas. Clin Imaging. 40(5):1047-54, 2016
                                            24. Hubbard JL et al: Criteria for excision of suspected fibroadenomas of the breast. Am J Surg. 209(2):297-301, 2015
                                            25. 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
                                            26. Plaza MJ et al: Phyllodes tumor: review of key imaging characteristics. Breast Dis. 35(2):79-86, 2015
                                            27. Sanders LM et al: The growing fibroadenoma. Acta Radiol Open. 4(4):2047981615572273, 2015
                                            28. 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
                                            29. 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
                                            30. 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
                                            31. 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
                                            32. 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
                                            33. Gupta P et al: Fibroadenoma in male breast: case report and literature review. Breast Dis. 33(1):45-8, 2011
                                            34. Kato F et al: Dynamic MR findings of ductal carcinoma in situ within a fibroadenoma. Magn Reson Med Sci. 10(2):129-32, 2011
                                            35. 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
                                            36. Narayanan D et al: Interpretation of positron emission mammography: feature analysis and rates of malignancy. AJR Am J Roentgenol. 196(4):956-70, 2011
                                            37. Slanetz PJ et al: Percutaneous excision: a viable alternative to manage benign breast lesions. Can Assoc Radiol J. 62(4):265-71, 2011
                                            38. 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
                                            39. Sanchez R et al: Breast fibroadenomas in the pediatric population: common and uncommon sonographic findings. Pediatr Radiol. 40(10):1681-9, 2010
                                            40. 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
                                            41. 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
                                            42. Park YM et al: Palpable breast masses with probably benign morphology at sonography: can biopsy be deferred? Acta Radiol. 49(10):1104-11, 2008
                                            43. Schrading S et al: Mammographic, US, and MR imaging phenotypes of familial breast cancer. Radiology. 246(1):58-70, 2008
                                            44. Sklair-Levy M et al: Incidence and management of complex fibroadenomas. AJR Am J Roentgenol. 190(1):214-8, 2008
                                            45. 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
                                            46. Doshi DJ et al: Complex cystic breast masses: diagnostic approach and imaging-pathologic correlation. Radiographics. 27 Suppl 1:S53-64, 2007
                                            47. 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
                                            48. Nurko J et al: Interim results from the FibroAdenoma Cryoablation Treatment Registry. Am J Surg. 190(4):647-51; discussion 651-2, 2005
                                            49. 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
                                            50. Strano S et al: Color Doppler imaging of fibroadenomas of the breast with histopathologic correlation. J Clin Ultrasound. 32(7):317-22, 2004
                                            51. El-Wakeel H et al: Systematic review of fibroadenoma as a risk factor for breast cancer. Breast. 12(5):302-7, 2003
                                            52. 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
                                            53. Sperber F et al: Diagnosis and treatment of breast fibroadenomas by ultrasound-guided vacuum-assisted biopsy. Arch Surg. 138(7):796-800, 2003
                                            54. 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
                                            Related Anatomy
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                                            Related Differential Diagnoses
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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

                                                                                      1. Abdul Hamid S et al: Radiopathological characteristics and outcomes of phyllodes tumor of the breast in Malaysian women. Medicine (Baltimore). 97(31):e11412, 2018
                                                                                      2. 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
                                                                                      3. 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
                                                                                      4. 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
                                                                                      5. 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
                                                                                      6. 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
                                                                                      7. Lee S et al: Frequency and outcomes of biopsy-proven fibroadenomas recommended for surgical excision. Clin Imaging. 50:31-36, 2018
                                                                                      8. Neville G et al: Is excision biopsy of fibroadenomas based solely on size criteria warranted? Breast J. ePub, 2018
                                                                                      9. 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
                                                                                      10. 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
                                                                                      11. 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
                                                                                      12. 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
                                                                                      13. 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
                                                                                      14. 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
                                                                                      15. Loke BN et al: Genetics and genomics of breast fibroadenomas. J Clin Pathol. ePub, 2017
                                                                                      16. 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
                                                                                      17. Namazi A et al: An evaluation of ultrasound features of breast fibroadenoma. Adv Biomed Res. 6:153, 2017
                                                                                      18. 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
                                                                                      19. Edwards T et al: Cellular fibroadenoma on core needle biopsy: management recommendations for the radiologist. Clin Imaging. 40(4):587-90, 2016
                                                                                      20. 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
                                                                                      21. Harvey JA et al: ACR appropriateness criteria palpable breast masses. J Am Coll Radiol. 13(11S):e31-e42, 2016
                                                                                      22. 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
                                                                                      23. Parsian S et al: Diffusion-weighted imaging reflects variable cellularity and stromal density present in breast fibroadenomas. Clin Imaging. 40(5):1047-54, 2016
                                                                                      24. Hubbard JL et al: Criteria for excision of suspected fibroadenomas of the breast. Am J Surg. 209(2):297-301, 2015
                                                                                      25. 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
                                                                                      26. Plaza MJ et al: Phyllodes tumor: review of key imaging characteristics. Breast Dis. 35(2):79-86, 2015
                                                                                      27. Sanders LM et al: The growing fibroadenoma. Acta Radiol Open. 4(4):2047981615572273, 2015
                                                                                      28. 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
                                                                                      29. 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
                                                                                      30. 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
                                                                                      31. 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
                                                                                      32. 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
                                                                                      33. Gupta P et al: Fibroadenoma in male breast: case report and literature review. Breast Dis. 33(1):45-8, 2011
                                                                                      34. Kato F et al: Dynamic MR findings of ductal carcinoma in situ within a fibroadenoma. Magn Reson Med Sci. 10(2):129-32, 2011
                                                                                      35. 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
                                                                                      36. Narayanan D et al: Interpretation of positron emission mammography: feature analysis and rates of malignancy. AJR Am J Roentgenol. 196(4):956-70, 2011
                                                                                      37. Slanetz PJ et al: Percutaneous excision: a viable alternative to manage benign breast lesions. Can Assoc Radiol J. 62(4):265-71, 2011
                                                                                      38. 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
                                                                                      39. Sanchez R et al: Breast fibroadenomas in the pediatric population: common and uncommon sonographic findings. Pediatr Radiol. 40(10):1681-9, 2010
                                                                                      40. 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
                                                                                      41. 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
                                                                                      42. Park YM et al: Palpable breast masses with probably benign morphology at sonography: can biopsy be deferred? Acta Radiol. 49(10):1104-11, 2008
                                                                                      43. Schrading S et al: Mammographic, US, and MR imaging phenotypes of familial breast cancer. Radiology. 246(1):58-70, 2008
                                                                                      44. Sklair-Levy M et al: Incidence and management of complex fibroadenomas. AJR Am J Roentgenol. 190(1):214-8, 2008
                                                                                      45. 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
                                                                                      46. Doshi DJ et al: Complex cystic breast masses: diagnostic approach and imaging-pathologic correlation. Radiographics. 27 Suppl 1:S53-64, 2007
                                                                                      47. 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
                                                                                      48. Nurko J et al: Interim results from the FibroAdenoma Cryoablation Treatment Registry. Am J Surg. 190(4):647-51; discussion 651-2, 2005
                                                                                      49. 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
                                                                                      50. Strano S et al: Color Doppler imaging of fibroadenomas of the breast with histopathologic correlation. J Clin Ultrasound. 32(7):317-22, 2004
                                                                                      51. El-Wakeel H et al: Systematic review of fibroadenoma as a risk factor for breast cancer. Breast. 12(5):302-7, 2003
                                                                                      52. 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
                                                                                      53. Sperber F et al: Diagnosis and treatment of breast fibroadenomas by ultrasound-guided vacuum-assisted biopsy. Arch Surg. 138(7):796-800, 2003
                                                                                      54. 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