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Zhou C, Fu W, Wei X, Zhang Z, Wang B, Fang X. Association between early-life mosquito repellents exposure and ADHD-like behaviours. J Public Health (Oxf) 2024:fdae076. [PMID: 38841748 DOI: 10.1093/pubmed/fdae076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 04/19/2024] [Accepted: 05/23/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Limited research has explored the impact of mosquito repellents exposure during early life on ADHD symptoms. This study aimed to explore the associations of exposure to mosquito repellents from pregnancy to 3 years old and the prevalence of ADHD-like behaviours among children aged 3-9 years, and further identify the sensitive exposure period. METHODS A cross-sectional study was conducted, including 12 275 children in Hefei City, China. Exposure was self-reported via primary caregivers. ADHD-like behaviours were measured by the Swanson, Nolan and Pelham, version IV scale (SNAP-IV), and Conners' Parent Rating Scale (CPRS). Cross-over analysis, binary logistic regression and linear regression were employed. RESULTS After adjusting for confounding variables, early-life exposure to mosquito repellents was associated with a higher risk of ADHD-like behaviours (OR = 1.81, 95% CI = 1.49-2.19). By comparing the strength of the association for each subgroup, we found exposure during 1-3 years old was a sensitive period (OR = 1.89, 95% CI = 1.25-2.87) by the cross-over analysis. Furthermore, we found a dose-response relationship in which the likelihood of ADHD-like behaviours increased with children's early-life mosquito repellents exposure dose. CONCLUSIONS Early-life exposure to mosquito repellents is linked with an elevated risk of ADHD-like behaviours in children, with a sensitive period identified during 1-3 years old.
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Affiliation(s)
- Cheng Zhou
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei 230032, China
| | - Weiwen Fu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei 230032, China
| | - Xinyu Wei
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei 230032, China
| | - Zixing Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei 230032, China
| | - Bin Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei 230032, China
| | - Xinyu Fang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei 230032, China
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Li Z, Yue X, Pan F, Yang L, Xiao Y, Mu D, Liu H, Chen M, Yin H, Huang H, Wang Z, Zhang C. A Comparison of Quality of Life, Cosmesis and Cost-Utility of Open Surgery, Vacuum-Assisted Breast Biopsy and High Intensity Focused Ultrasound for Breast Fibroadenoma. Acad Radiol 2024:S1076-6332(24)00201-0. [PMID: 38637238 DOI: 10.1016/j.acra.2024.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/27/2024] [Accepted: 03/27/2024] [Indexed: 04/20/2024]
Abstract
RATIONALE AND OBJECTIVES To compare the quality of life (QOL), cosmesis and cost-utility of open surgery (OS), vacuum-assisted breast biopsy (VABB) and high intensity focused ultrasound (HIFU) for fibroadenoma (FA). MATERIALS AND METHODS A total of 162 patients with 267 FAs were enrolled. Baseline characteristics and treatment information were recorded. Patients were followed up at 3-, 6- and 12-month post-treatment. QOL was evaluated by health survey. Breast cosmesis was evaluated by self-rating survey and Harvard Scale. A decision-analytic model was established and incremental cost was calculated for cost-utility analysis. RESULTS For QOL evaluation, there was no difference of physical component summary (PCS) score in three groups (P > 0.05), while the mental component summary (MCS) score was significantly higher in HIFU group than the other two groups at 3- and 6-month post-treatment (P < 0.05). The proportion of patients satisfied with breast cosmesis was significantly higher in HIFU group (96.49%) than in VABB group (54.90%) and OS group (49.99%) (P < 0.05). By Harvard Scale, 27.78%, 78.42% and 100.00% of patients were rated as excellent and good in OS group, VABB group and HIFU group, respectively (P < 0.05). To acquire a quality-adjusted life year (QALY), cost of OS, VABB and HIFU was 1034.31 USD, 1776.96 USD and 1277.67 USD, respectively. When compared to OS, incremental cost analysis showed HIFU was cost-effective, while VABB was not. CONCLUSION OS, VABB and HIFU were all effective and safe for FA, but among these three treatments, HIFU had the best QOL improvement, breast cosmesis and cost-effectiveness.
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Affiliation(s)
- Zi Li
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, China
| | - Xuewen Yue
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, China
| | - Feibao Pan
- Department of Cerebrovascular Disease, Suining Central Hospital, Suining 629000, China
| | - Lei Yang
- Department of Breast Surgery, Suining Central Hospital, Suining 629000, China
| | - Yao Xiao
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, China
| | - Dewu Mu
- Department of Breast Surgery, Suining Central Hospital, Suining 629000, China
| | - Hong Liu
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, China; NMPA Key Laboratory for Quality Evaluation of Ultrasonic Surgical Equipment, Wuhan 430075, China; National Engineering Research Center of Ultrasound Medicine, 1 Qingsong Road, Yubei District, Chongqing 401121, China
| | - Maoshan Chen
- Department of Breast Surgery, Suining Central Hospital, Suining 629000, China
| | - Hen Yin
- Department of Breast Surgery, Suining Central Hospital, Suining 629000, China
| | - Haoran Huang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, China; NMPA Key Laboratory for Quality Evaluation of Ultrasonic Surgical Equipment, Wuhan 430075, China; Chongqing Haifu Hospital, Chongqing 401120, China; National Engineering Research Center of Ultrasound Medicine, 1 Qingsong Road, Yubei District, Chongqing 401121, China
| | - Zhibiao Wang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, China; NMPA Key Laboratory for Quality Evaluation of Ultrasonic Surgical Equipment, Wuhan 430075, China; National Engineering Research Center of Ultrasound Medicine, 1 Qingsong Road, Yubei District, Chongqing 401121, China
| | - Cai Zhang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, China; NMPA Key Laboratory for Quality Evaluation of Ultrasonic Surgical Equipment, Wuhan 430075, China; Chongqing Haifu Hospital, Chongqing 401120, China; National Engineering Research Center of Ultrasound Medicine, 1 Qingsong Road, Yubei District, Chongqing 401121, China.
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3
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Ramala SR, Chandak S, Chandak MS, Annareddy S. A Comprehensive Review of Breast Fibroadenoma: Correlating Clinical and Pathological Findings. Cureus 2023; 15:e49948. [PMID: 38179396 PMCID: PMC10765224 DOI: 10.7759/cureus.49948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/05/2023] [Indexed: 01/06/2024] Open
Abstract
Breast fibroadenomas, common benign conditions, exhibit distinct clinical and histopathological features. This review highlights clinical presentation and histology correlations, providing insights for healthcare providers. Palpable masses, pain, and changes in breast appearance align with glandular and stromal components, emphasizing accurate diagnosis. Mammography, ultrasound, and MRI guide tailored treatment decisions. Challenges in differentiating atypical fibroadenomas highlight the need for meticulous histopathological evaluation. Clinical implications stress patient-centered care, shared decision-making, and ongoing follow-up. Future research focuses on genetic investigations and long-term studies. A multidisciplinary approach to breast fibroadenomas ensures comprehensive care for improved outcomes in both medical and emotional aspects.
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Affiliation(s)
- Sandeep Reddy Ramala
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Suresh Chandak
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Meenakshi S Chandak
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Srinivasulareddy Annareddy
- Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Pandit P, Murkey SP, Agarwal A, Jaiswal A, Agrawal S. Understanding Fibroadenoma of the Breast: A Comprehensive Review of Pre-operative and Post-operative Clinicopathological Correlations. Cureus 2023; 15:e51329. [PMID: 38288219 PMCID: PMC10823311 DOI: 10.7759/cureus.51329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/30/2023] [Indexed: 01/31/2024] Open
Abstract
Fibroadenomas of the breast are common benign lesions that predominantly affect young women. This review provides a comprehensive overview of fibroadenoma management, encompassing their definition, clinical presentation, diagnostic tools, surgical management, clinicopathological correlations, treatment outcomes, complications, and emerging research. Fibroadenomas typically present as palpable breast lumps, often with no associated nipple discharge, and their diagnosis relies on a combination of clinical examination, breast imaging, and pathological confirmation. Surgical interventions, including excisional biopsy and lumpectomy, offer symptom relief and favorable long-term outcomes. Minimally invasive techniques and ongoing research into genomics and molecular aspects hold promise for the future of fibroadenoma management. Multidisciplinary collaboration among healthcare providers is paramount, ensuring accurate diagnosis, personalized treatment decisions, and holistic patient care. As research advances, the management of fibroadenomas is poised to evolve, providing improved diagnostic accuracy, minimally invasive treatments, and enhanced patient outcomes.
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Affiliation(s)
- Pranam Pandit
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Siddhant P Murkey
- Medicine and Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Akash Agarwal
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Arpita Jaiswal
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Suyash Agrawal
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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5
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Zhang M, Arjmandi FK, Porembka JH, Seiler SJ, Goudreau SH, Merchant K, Hwang H, Hayes JC. Imaging and Management of Fibroepithelial Lesions of the Breast: Radiologic-Pathologic Correlation. Radiographics 2023; 43:e230051. [PMID: 37856317 DOI: 10.1148/rg.230051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Fibroepithelial lesions (FELs) are among the most common breast masses encountered by breast radiologists and pathologists. They encompass a spectrum of benign and malignant lesions, including fibroadenomas (FAs) and phyllodes tumors (PTs). FAs are typically seen in young premenopausal women, with a peak incidence at 20-30 years of age, and have imaging features of oval circumscribed hypoechoic masses. Although some FA variants are especially sensitive to hormonal influences and can exhibit rapid growth (eg, juvenile FA and lactational adenomas), most simple FAs are slow growing and involute after menopause. PTs can be benign, borderline, or malignant and are more common in older women aged 40-50 years. PTs usually manifest as enlarging palpable masses and are associated with a larger size and sometimes with an irregular shape at imaging compared with FAs. Although FA and FA variants are typically managed conservatively unless large and symptomatic, PTs are surgically excised because of the risk of undersampling at percutaneous biopsy and the malignant potential of borderline and malignant PTs. As a result of the overlap in imaging and histologic appearances, FELs can present a diagnostic challenge for the radiologist and pathologist. Radiologists can facilitate accurate diagnosis by supplying adequate tissue sampling and including critical information for the pathologist at the time of biopsy. Understanding the spectrum of FELs can facilitate and guide appropriate radiologic-pathologic correlation and timely diagnosis and management of PTs. Published under a CC BY 4.0 license. Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Meng Zhang
- From the Departments of Radiology (M.Z., F.K.A., J.H.P., S.J.S., S.H.G., K.M., J.C.H.) and Pathology (H.H.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
| | - Firouzeh K Arjmandi
- From the Departments of Radiology (M.Z., F.K.A., J.H.P., S.J.S., S.H.G., K.M., J.C.H.) and Pathology (H.H.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
| | - Jessica H Porembka
- From the Departments of Radiology (M.Z., F.K.A., J.H.P., S.J.S., S.H.G., K.M., J.C.H.) and Pathology (H.H.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
| | - Stephen J Seiler
- From the Departments of Radiology (M.Z., F.K.A., J.H.P., S.J.S., S.H.G., K.M., J.C.H.) and Pathology (H.H.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
| | - Sally H Goudreau
- From the Departments of Radiology (M.Z., F.K.A., J.H.P., S.J.S., S.H.G., K.M., J.C.H.) and Pathology (H.H.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
| | - Kanwal Merchant
- From the Departments of Radiology (M.Z., F.K.A., J.H.P., S.J.S., S.H.G., K.M., J.C.H.) and Pathology (H.H.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
| | - Helena Hwang
- From the Departments of Radiology (M.Z., F.K.A., J.H.P., S.J.S., S.H.G., K.M., J.C.H.) and Pathology (H.H.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
| | - Jody C Hayes
- From the Departments of Radiology (M.Z., F.K.A., J.H.P., S.J.S., S.H.G., K.M., J.C.H.) and Pathology (H.H.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
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Başara Akın I, Özgül H, Altay C, Seçil M, Durak MG, Gürel D, Balcı P. Use of shear-wave elastography to distinguish complex and complicated fibroadenomas from simple fibroadenomas. Diagn Interv Radiol 2023; 29:674-681. [PMID: 36994883 PMCID: PMC10679553 DOI: 10.4274/dir.2022.221615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 11/07/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE Simple fibroadenomas (SFAs), complex fibroadenomas (CFAs), and cellular fibroadenomas (CeFAs) are variants of fibroadenomas. Additionally, some degenerative, hyperplastic, and metaplastic changes may occur in fibroadenomas, forming complicated fibroadenomas. Distinctive ultrasonography (US) features in variants of fibroadenomas and complicated fibroadenomas have not been reported. Shear-wave elastography (SWE) can be applied to effectively discriminate between these variants and complicated fibroadenomas. In this study, we aimed to evaluate SWE findings to discriminate between SFAs and other variants. METHODS In total, 48 patients (26 with SFAs, 16 with CFAs, 3 with CeFAs, and 3 with complicated fibroadenomas) participated in this study. The lesions were classified into two groups according to histopathologic diagnoses. The SWE evaluation and lesion elasticity scores (Emax, Emean, and Emin) were both assessed in m/s and k/Pa, respectively. Two observers measured Emax, Emean, and Emin. Brightness (B)-mode US findings based on the Breast Imaging Reporting and Data System categorization and elasticity scores were recorded. In the statistical analyses, the chi-square test and non-parametric tests were performed. Fisher's exact test was used to compare independent groups, and Spearman's correlation coefficients were used to correlate the SWE data between the two observers. Additionally, receiver operating characteristic curves were analyzed to evaluate the diagnostic performance of the elasticity values. RESULTS The B-mode US features in both groups showed no statistical significance. The set of SWE values of both observers demonstrated strong statistical significance in discriminating between group 1 (SFAs) and Group 2 (CFAs, CeFAs, and complicated fibroadenomas). CONCLUSION As the fibroadenoma variants and complicated fibroadenomas have similar US findings, SWE in addition to a conventional B-mode examination can increase the diagnostic performance to discriminate SFAs from other complex and complicated forms of fibroadenomas.
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Affiliation(s)
- Işıl Başara Akın
- Department of Radiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Hakan Özgül
- Clinic of Radiology, Kemalpaşa State Hospital, İzmir, Turkey
| | - Canan Altay
- Department of Radiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Mustafa Seçil
- Department of Radiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Merih Güray Durak
- Department of Pathology, Dokuz Eylül University Faculty of Medicine, İzmir Turkey
| | - Duygu Gürel
- Department of Pathology, Dokuz Eylül University Faculty of Medicine, İzmir Turkey
| | - Pınar Balcı
- Department of Radiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
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Gonnah AR, Masoud O, AbdelWahab M, ElMosalamy A, Al-Naseem A. The Role of High Intensity Focused Ultrasound in the Treatment of Fibroadenomas: A Systematic Review. Breast Care (Basel) 2023; 18:279-288. [PMID: 37900548 PMCID: PMC10601662 DOI: 10.1159/000524738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 04/21/2022] [Indexed: 10/31/2023] Open
Abstract
Introduction Fibroadenomas are solid, mobile, and non-tender benign breast lumps, with highest prevalence amongst young women aged between 15 and 35. Symptoms can include discomfort, and they can become problematic, particularly when they enlarge, resulting in many referrals for biopsies, with fibroadenomas accounting for 30-75% of the cases. Diagnosis is based on triple assessment that involves a clinical examination, ultrasound imaging, and mammography, as well as core needle biopsies. Current management includes observation for 6-12 months, with the indication of definitive surgery, in cases that are older than 35 years or with fibroadenoma persistence. Serious adverse effects of surgery might include nipple areolar distortion, scarring, and damage to the breast tissue, as well as the risks associated with surgery and anesthesia, making it a non-feasible option. Methods A literature search was performed on the databases Embase, MEDLINE/PubMed, Google Scholar, and Ovid for English language papers published between January 1, 2000, and March 17, 2021. A structured protocol was employed to devise a comprehensive search strategy with keywords and Boolean operators defined by the research question. The keywords used for the search were "HIFU", "High Intensity Focused Ultrasound," "Fibroadenoma," "Breast," "Lesion." This review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results Recently, a thermal ablative technique, high intensity focused ultrasound (HIFU), was found to be a safe, noninvasive, and technically successful alternative, having displayed promising outcomes in reducing the volume of fibroadenomas, pain experienced by patients, and the length of hospitalization. Quality of life improvement was also evidenced, exhibited by the disappearance of symptoms, and enhanced physical activity post-intervention, in addition to patients' satisfaction with the cosmetic results and future recommendation of the procedure to other patients. Conclusion Overall, HIFU is a well-tolerated treatment associated, with low risk of complications, that can potentially include erythema, skin discoloration, and bruising with the majority of these self-resolving shortly after the procedure.
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Affiliation(s)
| | - Omar Masoud
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
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Chen Z, Zhang Y, Li W, Gao C, Huang F, Cheng L, Jin M, Xu X, Huang J. Single cell profiling of female breast fibroadenoma reveals distinct epithelial cell compositions and therapeutic targets. Nat Commun 2023; 14:3469. [PMID: 37328469 PMCID: PMC10275980 DOI: 10.1038/s41467-023-39059-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/26/2023] [Indexed: 06/18/2023] Open
Abstract
Fibroadenomas (FAs) are the most common breast tumors in women. No pharmacological agents are currently approved for FA intervention owing to its unclear mechanisms and a shortage of reproducible human models. Here, using single-cell RNA sequencing of human FAs and normal breast tissues, we observe distinct cellular composition and epithelial structural changes in FAs. Interestingly, epithelial cells exhibit hormone-responsive functional signatures and synchronous activation of estrogen-sensitive and hormone-resistant mechanisms (ERBB2, BCL2 and CCND1 pathways). We develop a human expandable FA organoid system and observe that most organoids seem to be resistant to tamoxifen. Individualized combinations of tamoxifen with ERBB2, BCL2 or CCND1 inhibitors could significantly suppress the viability of tamoxifen-resistant organoids. Thus, our study presents an overview of human FA at single-cell resolution that outlines the structural and functional differences between FA and normal breast epithelium and, in particular, provides a potential therapeutic strategy for breast FAs.
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Affiliation(s)
- Zhigang Chen
- Department of Breast Surgery (Surgical Oncology), Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang, China.
- Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province, Hangzhou, China.
- Cancer Centre, Zhejiang University, Hangzhou, Zhejiang, China.
| | - Yi Zhang
- Department of Breast Surgery (Surgical Oncology), Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang, China
- Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province, Hangzhou, China
- Cancer Centre, Zhejiang University, Hangzhou, Zhejiang, China
- Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Wenlu Li
- Departments of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02129, USA
| | - Chenyi Gao
- Department of Breast Surgery (Surgical Oncology), Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang, China
- Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province, Hangzhou, China
- Cancer Centre, Zhejiang University, Hangzhou, Zhejiang, China
- Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Fengbo Huang
- Department of Pathology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Lu Cheng
- Department of Pathology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Menglei Jin
- Department of Breast Surgery (Surgical Oncology), Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang, China
- Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province, Hangzhou, China
- Cancer Centre, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaoming Xu
- Department of Pathology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jian Huang
- Department of Breast Surgery (Surgical Oncology), Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang, China.
- Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province, Hangzhou, China.
- Cancer Centre, Zhejiang University, Hangzhou, Zhejiang, China.
- Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
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Cooper JM, Hilsenrath L, Yagudaev E, Safadi W. Idiopathic fibroadenoma in an elderly man. BMJ Case Rep 2023; 16:e255042. [PMID: 37247952 PMCID: PMC10230858 DOI: 10.1136/bcr-2023-255042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
A fibroadenoma within the male breast remains a rarely diagnosed entity. Though it was once believed that a fibroadenoma could not exist within a male breast, this has now been demonstrated as incorrect by several reported cases. Most have been in individuals with gynecomastia. There are only a handful of reported cases of men with a diagnosed fibroadenoma in the absence of gynecomastia. We describe a man in his 80s with a left breast fibroadenoma and no features of gynecomastia or hormonal alterations. Based on our findings, we suggest that for men of all ages presenting with a breast lesion, a fibroadenoma remains a possible diagnosis.
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Affiliation(s)
- Jonah Max Cooper
- Medical School for International Health, Ben-Gurion University of the Negev Faculty of Health Sciences, Beer-Sheva, Southern, Israel
| | - Lior Hilsenrath
- Medical School for International Health, Ben-Gurion University of the Negev Faculty of Health Sciences, Beer-Sheva, Southern, Israel
| | - Eva Yagudaev
- Medical School for International Health, Ben-Gurion University of the Negev Faculty of Health Sciences, Beer-Sheva, Southern, Israel
| | - Wajdi Safadi
- Department of Surgery, Clalit Health Services, Golan Heights, Israel
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10
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Fraker JL, Clune CG, Sahni SK, Yaganti A, Vegunta S. Prevalence, Impact, and Diagnostic Challenges of Benign Breast Disease: A Narrative Review. Int J Womens Health 2023; 15:765-778. [PMID: 37223067 PMCID: PMC10202205 DOI: 10.2147/ijwh.s351095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 05/05/2023] [Indexed: 05/25/2023] Open
Abstract
Benign breast diseases, which are commonly seen in clinical practice, have various clinical presentations and implications, as well as management strategies. This article describes common benign breast lesions, presentations of these lesions, and typical radiographic and histologic findings. Also included in this review are the most recent data and guideline-based recommendations for the management of benign breast diseases at diagnosis, including surgical referral, medical management, and ongoing surveillance.
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Affiliation(s)
- Jessica L Fraker
- Division of Women’s Health Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Caroline G Clune
- Center for Breast Care, Mayo Clinic Health System — Southwest Wisconsin Region, La Crosse, WI, USA
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sabrina K Sahni
- Jacoby Center for Breast Health, Mayo Clinic, Jacksonville, FL, USA
| | - Avani Yaganti
- Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Suneela Vegunta
- Division of Women’s Health Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
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11
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van de Voort EM, Struik GM, Birnie E, Sinke RH, Verver D, van Streun SP, Macco M, Verhoef C, Klem TM. Implementation of vacuum-assisted excision as a management option for benign and high-risk breast lesions. Br J Radiol 2023:20220776. [PMID: 37171394 DOI: 10.1259/bjr.20220776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVE Previous studies have shown that vacuum-assisted excision (VAE) is a safe and effective alternative for surgical excision (SE) of benign breast lesions. However, the use of VAE in high-risk lesions is controversial and guidelines are ambiguous. This study describes the impact of the implementation of VAE in terms of management and outcomes compared to a cohort before implementation. METHODS A single centre retrospective study with two cohorts: 'before' and 'after' implementation of VAE was performed. All patients with a benign or high-risk lesion treated by VAE or SE between 2016 and 2019 were included. Excision, complication, and upgrade rates were compared between both cohorts. Cox regression was used for the evaluation of recurrences and re-excisions. RESULTS The overall excision rate of all benign and high-risk lesions was comparable in both cohorts (17% vs 16%, p = 0.700). After implementation, benign lesions were significantly more often managed by VAE (101/151, 67%, p < 0.001). Re-excision, recurrence, and complication rates were low and comparable between cohorts (4.3% vs 3.9%, p > 0.999; 3.0 vs 2.0%, p = 0.683; 3.4 vs 6.6%, p = 0.289, respectively). CONCLUSION SE could safely be replaced by VAE in 58% of patients treated for a benign or high-risk lesion. With this shift in management, the use of operating rooms and general anaesthesia can safely be omitted in this patient group. Further research on high-risk lesions is warranted since our data are exploratory. ADVANCES IN KNOWLEDGE This study provides supportive data for the use of VAE as a management option for both benign (up to 5 cm) and high-risk lesions. Outcomes on re-excision, recurrence should be confirmed in prospective studies especially in high-risk lesions.
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Affiliation(s)
- Elles Mf van de Voort
- Department of Surgery, Franciscus Gasthuis, Rotterdam, Netherlands
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Doctor Molewaterplein, Rotterdam, Netherlands
| | - Gerson M Struik
- Department of Surgery, Franciscus Gasthuis, Rotterdam, Netherlands
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Doctor Molewaterplein, Rotterdam, Netherlands
- Department of Surgery, Reinier de Graaf Gasthuis, Reinier de Graafweg, Netherlands
| | - Erwin Birnie
- Department of Statistics and Education, Franciscus Gasthuis & Vlietland, Kleiweg, Rotterdam, Netherlands
- Department of Genetics, University Medical Center Groningen, University of Groningen, Hanzeplein, Groningen, Netherlands
| | - Renata Hja Sinke
- Department of Pathology, Franciscus Gasthuis & Vlietland, Kleiweg, Rotterdam, Netherlands
| | - Daniëlle Verver
- Department of Surgery, Franciscus Gasthuis, Rotterdam, Netherlands
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Doctor Molewaterplein, Rotterdam, Netherlands
| | | | - Maura Macco
- Department of Radiology, Franciscus Gasthuis & Vlietland, Kleiweg, Rotterdam, Netherlands
| | - C Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Doctor Molewaterplein, Rotterdam, Netherlands
| | - Taco Mal Klem
- Department of Surgery, Franciscus Gasthuis, Rotterdam, Netherlands
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12
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Zhang Y, Huang J, Zhou L, Leng Y. The largest and heaviest giant juvenile fibroadenoma of the breast in the Chinese population: A case report. Medicine (Baltimore) 2023; 102:e33422. [PMID: 37000060 PMCID: PMC10063306 DOI: 10.1097/md.0000000000033422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/13/2023] [Indexed: 04/01/2023] Open
Abstract
RATIONALE Fibroadenoma is the most common benign tumor of the breast, but giant juvenile fibroadenoma exceeding 20 cm is much rare. This report presents the largest and heaviest giant juvenile fibroadenoma in an 18-year-old Chinese girl. DIAGNOSIS AND INTERVENTIONS An 18-year-old adolescent girl with a 2-year history of a large left breast mass with progressive expansion over 11 months. A 28 × 21 cm soft swelling occupied the entire outer quadrants of the left breast. The huge mass sagged below the belly button, resulting in high asymmetry of the shoulders. Contralateral breast examination results were normal except for hypopigmentary detected on the nipple-areola complex. Under general anesthesia, the lump was completely excised along the outer envelope of the tumor, while reserving excessive resection of the skin. The patient's postoperative recovery was uneventful, and the surgical wound healed well. OUTCOMES A radial incision operation was finally performed to remove the huge mass and to preserve the normal breast tissue and the nipple-areolar complex, not only considering the aesthetics but also preserving the ability to lactate. LESSONS Currently, there is a lack of clear guidelines regarding the diagnostic and treatment modalities for a giant juvenile fibroadenoma. The principle of surgical choice is to balance aesthetics and function preservation.
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Affiliation(s)
- Yuanxin Zhang
- Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Department of Breast Surgery, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, China
| | - Junhua Huang
- Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Department of Breast Surgery, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, China
| | - Ling Zhou
- Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Department of Breast Surgery, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, China
| | - Ying Leng
- Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Department of Breast Surgery, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, China
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13
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Shrateh ON, Doudin DRA, Torman Y, Abulihya M. Spontaneous infarction of breast fibroadenoma unrelated to any known risk factor: A case report. Int J Surg Case Rep 2023; 105:108031. [PMID: 36965440 PMCID: PMC10073882 DOI: 10.1016/j.ijscr.2023.108031] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 03/01/2023] [Accepted: 03/22/2023] [Indexed: 03/27/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Fibroadenoma is one of the most common benign breast neoplasms, primarily affecting adolescents and young women. Infarction is uncommon in fibroadenomas, and when it occurs, it is usually associated with pregnancy or lactation, as well as FNA. We present a case of spontaneous infarction of breast fibroadenoma that was unrelated to the aforementioned risk factors and occurred outside of pregnancy and lactation. CASE PRESENTATION A 22-year-old female presented with painful left breast lump with a sudden increase in size for 1 week duration. Physical examination revealed an irregular, well-defined, and mobile mass in the left breast measuring 5 cm × 4 cm. The mass was firm in consistency and showed tenderness. The clinical diagnosis of benign fibroadenoma of the breast was made and confirmed radiologically. A biopsy was planned. Microscopical examination showed pictures consistent with spontaneous infarction of benign fibroadenoma of the breast. CLINICAL DISCUSSION One case of infarcted fibroadenoma was diagnosed after one excision biopsy. No preceding fine-needle aspiration biopsy was performed in this case, nor was the patient pregnant or lactating at the time of the diagnosis. CONCLUSION Spontaneous infarction within fibroadenoma is a rare phenomenon in young females. The presence of painful lumps in fibroadenoma patients should be cautiously interpreted and diagnosed.
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Affiliation(s)
- Oadi N Shrateh
- Al-Quds University-School of Medicine, Abu-Dis, Jerusalem, Palestine.
| | - Duha R A Doudin
- Al-Quds University-School of Medicine, Abu-Dis, Jerusalem, Palestine
| | - Yousef Torman
- Al-Quds University-School of Medicine, Abu-Dis, Jerusalem, Palestine
| | - Mohand Abulihya
- Pathology Department, Al-Istishari Arab Hospital, Ramallah, West Bank, Palestine.
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14
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Eleftheriades A, Tsarna E, Toutoudaki K, Paschalidou E, Christopoulos N, Georgopoulos I, Mitropoulou G, Christopoulos P. Giant Juvenile Fibroadenoma: Case Report and Review of the Literature. J Clin Med 2023; 12:jcm12051855. [PMID: 36902642 PMCID: PMC10003210 DOI: 10.3390/jcm12051855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 03/02/2023] Open
Abstract
Fibroadenomas are common benign breast tumors. Fibroadenomas that exceed 5 cm in diameter, weigh more than 500 g, or replace more than four-fifths of the breast are characterized as giant. A fibroadenoma diagnosed in patients during childhood or adolescence is characterized as juvenile. An extensive PubMed search of the literature in English up until August 2022 was performed. In addition, a rare case of a gigantic fibroadenoma in an 11-year-old premenarchal girl who was referred to our adolescent gynecology center is presented here. Eighty-seven cases of giant juvenile fibroadenomas have been reported in the literature along with our case. Patients with giant juvenile fibroadenoma presented at a mean age of 13.92 years and usually after menarche. Juvenile fibroadenomas are usually unilateral, occurring either in the right or the left breast; the majority of them are diagnosed when they are already more than 10 cm in size, and they are most frequently treated with total lump excision. Differential diagnosis includes phyllodes tumors and pseudo-angiomatous stromal hyperplasia. Conservative management is feasible, but surgical excision is recommended to patients with suspicious imaging features or when the mass grows rapidly.
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Affiliation(s)
- Anna Eleftheriades
- Postgraduate Programme “Maternal Fetal Medicine”, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Ermioni Tsarna
- Second Department of Obstetrics and Gynecology, “Aretaieion” Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Konstantina Toutoudaki
- Second Department of Obstetrics and Gynecology, “Aretaieion” Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Eleni Paschalidou
- Second Department of Obstetrics and Gynecology, “Aretaieion” Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | | | - Ioannis Georgopoulos
- Department of Pediatric Surgery, “Agia Sofia” Children’s Hospital, 11527 Athens, Greece
| | - Georgia Mitropoulou
- Department of Pathology, “Agia Sofia” Children’s Hospital, 11527 Athens, Greece
| | - Panagiotis Christopoulos
- Second Department of Obstetrics and Gynecology, “Aretaieion” Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
- Correspondence:
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15
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"Growing fibroadenoma": Are there clinical and pathological features predicting a phyllodes tumor on surgical excision? Ann Diagn Pathol 2023; 62:152069. [PMID: 36527840 DOI: 10.1016/j.anndiagpath.2022.152069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/07/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022]
Abstract
In cases of growth of FA on imaging, core needle biopsies (CNB) are often performed to rule out phyllodes tumor (PT). We aim to focus on "growing FAs" and to identify clinical and histopathologic features that are likely to predict a PT on excision. Thirty-four FAs with radiologic documentation of growth were included. Various clinical and pathological features such as age, body mass index (BMI), lesion size, and growth rate were recorded. On excision, 17 cases (50 %) were FAs, whereas 16 (47 %) were re-classified as benign PT despite only 19 % being suspicious for PT on CNB. PT patients were older (mean age 42.6) than those with FAs (mean age 28.2), p = 0.0002. All false negative cases demonstrated intracanalicular growth. Mitotic rate was the most significant histologic feature in PT on excision compared to others, such as lesion circumscription and stromal cellularity. Recognition and careful counting of mitotic rate, especially with intracanalicular patterns in growing FAs, can potentially prevent missing a PT on CNB. In patients with "growing FAs" who are ≥40 years of age, excision may be recommended due to the high likelihood of PT diagnosis on excision and high false negative rate on CNB.
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16
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Brouwer de Koning IM, van Heusden HC, Mol SJJ, Rots ML, Draaisma WA, Bosscha K. A rapidly growing fibroadenoma in a pregnant woman: A case report. Breast Dis 2023; 42:325-330. [PMID: 37899052 DOI: 10.3233/bd-230030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
BACKGROUND Fibroadenomas are the most common benign breast lesions in women. They present as a unilateral mass and can rapidly enlarge in size through hormonal changes. Fibroadenomas could be classified as small or giant, and as simple or complex. They are classified as 'giant' when the size exceeds 5 cm and/or weight 500 gram; and as 'complex' if one of the following characteristics is present: cysts with a size >3 mm, epithelial calcifications, sclerosing adenosis and papillary apocrine metaplasia. Giant fibroadenomas can cause compression of surrounding breast tissue or breast asymmetry, requiring surgical excision in order to preserve a normal breast shape. CASE A 26-year-old pregnant woman was referred with a palpable mass of her right breast. The mass rapidly increased in size to a diameter of 13 cm during the second trimester of her pregnancy. A tru-cut biopsy confirmed a fibroadenoma. The rapid growth and compression of normal breast tissues indicated a lumpectomy during her pregnancy. The mass was easily excised without any consequences for the pregnancy. Pathological examination showed a complex giant fibroadenoma. CONCLUSION A unique case of a pregnant woman with rapid progression of a fibroadenoma that met the criteria of a complex and giant fibroadenoma, was presented. This case emphasizes the importance of timely surgical intervention, even during pregnancy, to prevent permanent breast tissue damage.
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Affiliation(s)
| | - H C van Heusden
- Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - S J J Mol
- Department of Pathology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - M L Rots
- Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - W A Draaisma
- Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - K Bosscha
- Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
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17
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Mon KS, Tang P. Fibroepithelial Lesions of the Breast: Update on Molecular Profile With Focus on Pediatric Population. Arch Pathol Lab Med 2023; 147:38-45. [PMID: 35776911 DOI: 10.5858/arpa.2022-0011-ra] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 12/31/2022]
Abstract
CONTEXT.— This review article derives from the breast pathology lecture at the Eighth Princeton Integrated Pathology Symposium (PIPS VIII). OBJECTIVE.— To provide a literature review and update on fibroepithelial lesions of the breast with molecular findings and findings regarding the pediatric population. DATA SOURCES.— The sources include extensive literature review, personal research, and experience. CONCLUSIONS.— Given significant differences in prognosis and management of fibroepithelial lesions, we aim to provide readers with pertinent definitions, pathomorphology, molecular findings, and management for each diagnosis, with insights on the pediatric population.
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Affiliation(s)
- Khin Su Mon
- From the Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Ping Tang
- From the Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
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18
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Liang M, Zhang Z, Zhang C, Chen R, Xiao Y, Li Z, Li T, Liu Y, Ling L, Xie H, Chen L, Liu X, Wang S, Xia T. Feasibility and efficacy of ultrasound-guided high-intensity focused ultrasound of breast fibroadenoma. Int J Hyperthermia 2023; 40:2240548. [PMID: 37544652 DOI: 10.1080/02656736.2023.2240548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/03/2023] [Accepted: 07/19/2023] [Indexed: 08/08/2023] Open
Abstract
OBJECTIVE This nonrandomized prospective clinical trial aimed to assess the efficacy, safety and follow-up outcomes of ultrasound-guided high-intensity focused ultrasound (USgHIFU) surgery in patients with breast fibroadenoma. METHODS With the approval of the institutional ethics committee and written informed consent, a total of 113 patients diagnosed with breast fibroadenoma by core-needle biopsy in our hospital were recruited. USgHIFU surgery was performed under local anesthesia. Contrast-enhanced ultrasound (CEUS) or contrast-enhanced MRI (CEMRI) was performed to evaluate the nonperfused volume (NPV). The patients were followed up with physical examination and ultrasound imaging. RESULTS The clinical outcome of 85 patients with 147 fibroadenomas with a follow-up time of more than 3 months was analyzed in this study. Fifty-two patients had one lesion, twenty-one patients had two lesions and twelve patients had more than two lesions. During USgHIFU, the median localization time for all fibroadenomas was 3 (interquartile range: 1, 5) min, and the median treatment time was 9 (interquartile range: 5, 15) min. Under local anesthesia, all the patients tolerated the treatment well. No serious epidermal burns were observed in any of the patients. Based on CEUS or CEMRI imaging evaluation, the median NPV ratio was 100% (interquartile range: 79.2%, 116.8%). The VRR were 26.77 ± 50.05%, 50.22 ± 42.01% and 72.74 ± 35.39% at 3-6 months, 6-12 months and >12 months, respectively, which showed significant statistical difference (p < .001). CONCLUSION Ultrasound-guided HIFU surgery is an effective and safe noninvasive alternative technique for the treatment of breast fibroadenoma.
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Affiliation(s)
- Mengdi Liang
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Zhizheng Zhang
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Cai Zhang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Chongqing Haifu Hospital, Chongqing, China
- National Engineering Research Center of Ultrasound Medicine, Chongqing, China
| | - Rui Chen
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yao Xiao
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Zi Li
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Tao Li
- Department of Pathology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yuelin Liu
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Lijun Ling
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Hui Xie
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Lin Chen
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Xiaoan Liu
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Shui Wang
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Tiansong Xia
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
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Hutchings HA, Remesh A. An evaluation of the readability and visual appearance of online patient resources for fibroadenoma. PLoS One 2022; 17:e0277823. [PMID: 36399450 PMCID: PMC9674151 DOI: 10.1371/journal.pone.0277823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 11/04/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Fibroadenomas are benign lesions found in the breast tissue. Widespread access to and use of the internet has resulted in more individuals using online resources to better understand health conditions, their prognosis and treatment. The aim of this study was to investigate the readability and visual appearance of online patient resources for fibroadenoma. METHODS We searched GoogleTM, BingTM and YahooTM on 6 July 2022 using the search terms "fibroadenoma", "breast lumps", "non-cancerous breast lumps", "benign breast lumps" and "benign breast lesions" to identify the top ten websites that appeared on each of the search engines. We excluded advertised websites, links to individual pdf documents and links to blogs/chats. We compiled a complete list of websites identified using the three search engines and the search terms and analysed the content. We only selected pages that were relevant to fibroadenoma. We excluded pages which only contained contact details and no narrative information relating to the condition. We did not assess information where links were directed to alternative websites. We undertook a qualitative visual assessment of each of the websites using a framework of pre-determined key criteria based on the Centers for Medicare and Medicaid Services toolkit. This involved assessing characteristics such as overall design, page layout, font size and colour. Each criterion was scored as: +1- criterion achieved; -1- criterion not achieved; and 0- no evidence, unclear or not applicable (maximum total score 43). We then assessed the readability of each website to determine the UK and US reading age using five different readability tests: Flesch Kincaid, Gunning Fog, Coleman Liau, SMOG, and the Automated Readability Index. We compared the readability scores to determine if there were any significant differences across the websites identified. We also generated scores for the Flesh Reading Ease as well as information about sentence structure (number of syllables per sentence and proportion of words with a high number of syllables) and proportion of people the text was readable to. RESULTS We identified 39 websites for readability and visual assessment. The visual assessment scores for the 39 websites identified ranged from -19 to 31 points out of a possible score of 43. The median readability score for the identified websites was 8.58 (age 14-15), with a range of 6.69-12.22 (age 12-13 to university level). There was a statistically significant difference between the readability scores obtained across websites (p<0.001). Almost half of the websites (18/39; 46.2%) were classified as very difficult by the Flesch Reading Ease score, with only 13/39 (33.33%) classified as being fairly easy or plain English. CONCLUSION We found wide differences in the general appearance, layout and focus of the fibroadenoma websites identified. The readability of most of the websites was also much higher than the recommended level for the public to understand. Fibroadenoma website information needs to be simplified to reduce the use of jargon and specificity to the condition for individuals to better comprehend it. In addition, their visual appearance could be improved by changing the layout and including images and diagrams.
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Affiliation(s)
- Hayley Anne Hutchings
- School of Medicine, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, United Kingdom
- * E-mail:
| | - Anagha Remesh
- School of Medicine, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, United Kingdom
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20
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Hudson-Phillips S, Graham G, Cox K, Al Sarakbi W. Fibroadenoma: a guide for junior clinicians. Br J Hosp Med (Lond) 2022; 83:1-9. [PMID: 36322437 DOI: 10.12968/hmed.2022.0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Fibroadenoma is the most common cause of benign breast lumps and is typically seen in women under the age of 40 years. Fibroadenomas are classified as simple, complex, giant, myxoid or juvenile. They present as smooth, rubbery, mobile masses on palpation. Ultrasonographic and mammographic features typical of fibroadenomas include solid, round, well-circumscribed masses, with or without lobulated features. They are predominantly treated conservatively although clinical pathways recommend referral for triple assessment. Surgical intervention is indicated by the presence of one or more of the following features: the presence of symptoms, a diameter greater than 2 cm, rapid growth rate, complex features, disease recurrence or patient anxiety.
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Affiliation(s)
| | - Gemma Graham
- Department of General Surgery, Epsom and St Helier Hospital, London, UK
| | - Kofi Cox
- Department of Medicine, St George's University of London, London, UK
| | - Wail Al Sarakbi
- Department of Oncoplastic Breast Surgery, Croydon University Hospital, London, UK
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21
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Xiao Y, Liang M, Chen M, Li Z, Xia T, Yue X, Yin H, Yang H, Huang H, Wang Z, Zhang C. Evaluating the learning curve of high intensity focus ultrasound for breast fibroadenoma by CUSUM analysis: a multi-center study. Int J Hyperthermia 2022; 39:1238-1244. [PMID: 36123038 DOI: 10.1080/02656736.2022.2123566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
OBJECTIVE To explore the learning curve of high intensity focus ultrasound (HIFU) treatment for breast fibroadenoma. METHODS A database of 110 patients with 255 breast fibroadenomas who underwent HIFU treatment at two different clinical centers (Center 1 and 2) were retrospectively analyzed. The learning curves of HIFU treatment for breast fibroadenoma were drawn by CUSUM analysis in two centers, respectively. According to the inflection point of the learning curves, the treatment was divided into two groups: initial phase and consolidation phase. HIFU treatment parameters were compared between two groups. The effectiveness and safety results were also evaluated. RESULTS The inflection points of the learning curves were the 60th treatment in Center 1 and the 65th treatment in Center 2. The screening time, treatment time, sonication time and hyperechoic scale change time were significantly shorter in consolidation phase than those in initial phase of the two centers (p < 0.05). There were no differences in non-perfused volume (NPV) ratio and energy effect factor (EEF) between the two groups in Center 1, while in Center 2, these above-mentioned results in consolidation phase led to a greater improvement than those in initial phase. There was no difference of Visual Analogue Scale (VAS) scores and no adverse event observed in both centers. CONCLUSION HIFU treatment for breast fibroadenoma was effective and safe. The learning curve of HIFU treatment for breast fibroadenoma can be completed after treating 60-65 tumors without increasing the safety risk.
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Affiliation(s)
- Yao Xiao
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Mengdi Liang
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Maoshan Chen
- Department of Breast Surgery, Suining Central Hospital, Suining, China
| | - Zi Li
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Tiansong Xia
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Xuewen Yue
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Heng Yin
- Department of Breast Surgery, Suining Central Hospital, Suining, China
| | - Hongwei Yang
- Department of Breast Surgery, Suining Central Hospital, Suining, China
| | - Haoran Huang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.,Chongqing Haifu Hospital, Chongqing, China
| | - Zhibiao Wang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Cai Zhang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.,Chongqing Haifu Hospital, Chongqing, China
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22
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Liang M, Zhang C, Xia T, Chen R, Wang X, Weng M, Xie H, Chen L, Liu X, Wang S. Ultrasound radiomics features predicting the dosimetry for focused ultrasound surgery of benign breast tumor: A retrospective study. Front Genet 2022; 13:969409. [PMID: 36118892 PMCID: PMC9479455 DOI: 10.3389/fgene.2022.969409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/17/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose: To investigate the correlation between pre-ablation ultrasound radiomics features and the sonication energy for focused ultrasound surgery (FUS) of benign breast tumors. Method: 53 benign breast tumors of 28 patients treated by ultrasound-guided focused ultrasound surgery (USgFUS) were included in this study. The sonication energy per unit volume of each tumor was calculated. Three-quarter point was chosen as the cut-off to divide the 53 included tumors into high sonication energy (HSE, n = 14) and low sonication energy (LSE, n = 39) groups. For each tumor, the region of interest (ROI) of both the tumor itself (tROI) and the near field tissue (nfROI) were delineated and analyzed separately using ImageJ software. Pearson correlation coefficient and multiple linear regression analysis were used for radiomics feature selection. To explore the diagnostic performance of different ultrasound radiomics features, a receiver operating characteristic (ROC) curve analysis was performed. Results: In total of 68 radiomics features were extracted from pre-ablation ultrasound images of each tumor. Of all radiomics features, BX in tROI (p < 0.001), BX (p = 0.001) and Circ (p = 0.019) in nfROI were independently predictive features of sonication energy per unit volume. The ROC curves showed that the area under the curve (AUC) values of BX in tROI, BX, and Circ in nfROI were 0.797, 0.787 and 0.822, respectively. Conclusion: This study provided three radiomics features of pre-ablation ultrasound image as predictors of sonication dose for FUS in benign breast tumors. Further clinical trials are needed to confirm the predictive effect of these radiomics features.
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Affiliation(s)
- Mengdi Liang
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Cai Zhang
- State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Tiansong Xia
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
- State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Rui Chen
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Xinyang Wang
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Miaomiao Weng
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Hui Xie
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Lin Chen
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Xiaoan Liu
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
- *Correspondence: Xiaoan Liu, ; Shui Wang,
| | - Shui Wang
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
- *Correspondence: Xiaoan Liu, ; Shui Wang,
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23
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Hoxhaj A, Drissen MM, Vos JR, Bult P, Mann RM, Hoogerbrugge N. The yield and effectiveness of breast cancer surveillance in women with PTEN Hamartoma Tumor Syndrome. Cancer 2022; 128:2883-2891. [PMID: 36533707 PMCID: PMC9543294 DOI: 10.1002/cncr.34326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/02/2022] [Accepted: 05/10/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Women with PTEN Hamartoma Tumor Syndrome (PHTS) are offered breast cancer (BC) surveillance because of an increased BC lifetime risk. Surveillance guidelines are, however, expert opinion-based because of a lack of data. We aimed to assess the yield and effectiveness of BC surveillance and the prevalence and type of breast disease in women with PHTS. METHODS Sixty-five women with PHTS who visited our center between 2001 and 2021 were included. Surveillance consisted of annual magnetic resonance imaging (MRI) and mammography from ages 25 and 30 years, respectively. RESULTS Thirty-nine women enrolled in the BC surveillance program (median age at first examination, 38 years [range, 24-70]) and underwent 156 surveillance rounds. Surveillance led to detection of BC in 7/39 women (cancer detection rate [CDR], 45/1000 rounds) and benign breast lesions (BBLs) in 11/39 women. Overall sensitivity2 (which excludes prophylactic-mastectomy detected BCs) was 100%, whereas sensitivity2 of mammography and MRI alone was 50% and 100%, respectively. Overall specificity was higher in follow-up rounds (86%) versus first rounds (71%). Regardless of surveillance, 21/65 women developed 35 distinct BCs (median age at first diagnosis, 40 years [range, 24-59]) and 23/65 developed 89 BBLs (median age at first diagnosis, 38 years [range, 15-61]). Surveillance-detected BCs were all T1 and N0, whereas outside surveillance-detected BCs were more often ≥T2 (60%) and N+ (45%) (p < .005). CONCLUSIONS The findings show that annual BC surveillance with MRI starting at age 25 years enables detection of early-stage BCs. Performance measures of surveillance and CDR were both high. BBLs were commonly present, underlining the importance of evaluation of all lesions independently. LAY SUMMARY Breast cancer surveillance leads to decreased tumor stage and improved survival. Breast cancer surveillance with breast magnetic resonance imaging from age 25 years onward is recommended.
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Affiliation(s)
- Alma Hoxhaj
- Department of ImagingRadboud University Medical CenterNijmegenThe Netherlands,Department of Radiology and Nuclear Medicinethe Netherlands Cancer Institute, Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands,Radboud University Medical CenterRadboud Institute for Health SciencesNijmegenThe Netherlands
| | - Meggie M.C.M. Drissen
- Radboud University Medical CenterRadboud Institute for Health SciencesNijmegenThe Netherlands,Department of Human GeneticsRadboud University Medical CenterNijmegenThe Netherlands
| | - Janet R. Vos
- Radboud University Medical CenterRadboud Institute for Health SciencesNijmegenThe Netherlands,Department of Human GeneticsRadboud University Medical CenterNijmegenThe Netherlands,European Reference Network Genetic Tumour Risk Syndromes (ERN GENTURIS)NijmegenThe Netherlands
| | - Peter Bult
- Department of PathologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Ritse M. Mann
- Department of ImagingRadboud University Medical CenterNijmegenThe Netherlands,Department of Radiology and Nuclear Medicinethe Netherlands Cancer Institute, Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
| | - Nicoline Hoogerbrugge
- Radboud University Medical CenterRadboud Institute for Health SciencesNijmegenThe Netherlands,Department of Human GeneticsRadboud University Medical CenterNijmegenThe Netherlands,European Reference Network Genetic Tumour Risk Syndromes (ERN GENTURIS)NijmegenThe Netherlands,Department of PathologyRadboud University Medical CenterNijmegenThe Netherlands
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24
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Radiomics analysis of ultrasonic image predicts sensitive effects of microwave ablation in treatment of patient with benign breast tumors. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2022.103722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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25
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Mousa-Doust D, Dingee CK, Chen L, Bazzarelli A, Kuusk U, Pao JS, Warburton R, McKevitt EC. Excision of breast fibroepithelial lesions: when is it still necessary?-A 10-year review of a regional centre. Breast Cancer Res Treat 2022; 194:307-314. [PMID: 35639263 DOI: 10.1007/s10549-022-06631-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/09/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Fibroepithelial lesions (FEL) range from benign fibroadenoma (FA) to malignant phyllodes tumor (PT), but can be difficult to diagnose on core needle biopsy (CNB). This study assesses risk factors for phyllodes tumor (PT) and recurrence and whether a policy to excise FELs over 3 cm in size is justified. METHODS Patients having surgery for FELs from 2009 to 2018 were identified. The association of clinical, radiology and pathological features with PT and recurrence were evaluated. Trend analysis was used to assess risk of PT based on imaging size. RESULTS Of the 616 patients with FELs, 400 were identified as having FA on CNB and 216 were identified as having FEL with a comment of concern for phyllodes tumor (query PT, QPT). PT was identified in 107 cases; 28 had CNB of FA (7.0%), while 79 had QPT (36.6%). Follow-up was available for 86 with a mean of 56 months; six patients had recurrence of PT, all of whom had QPT on CNB. The finding of PT was associated with CNB of QPT, increasing age and size on multivariate logistic regression. All patients diagnosed with PT following CNB of FA had enlarging lesions with a mean size of 38.3 mm. CONCLUSIONS Our data does not support routine excision of FELs based on size alone. All patients with QPT on CNB, regardless of size should consider excision due to high risk of PT and recurrence, and the decision to excise FAs to rule out PT should also consider whether the lesion is enlarging.
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Affiliation(s)
- Dorsa Mousa-Doust
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Carol K Dingee
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada.,Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Leo Chen
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Amy Bazzarelli
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada.,Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Urve Kuusk
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada.,Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Jin-Si Pao
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada.,Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Rebecca Warburton
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada.,Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Elaine C McKevitt
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada. .,Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.
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26
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Zhang C, Liang M, Xia T, Yin H, Yang H, Wang Z, Zhang L. Dosimetric analysis of ultrasound-guided high intensity focused ultrasound ablation for breast fibroadenomas: a retrospective study. Int J Hyperthermia 2022; 39:743-750. [PMID: 35634911 DOI: 10.1080/02656736.2022.2074151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Cai Zhang
- College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Mengdi Liang
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Tiansong Xia
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Heng Yin
- Suining Central Hospital, Suining, China
| | | | - Zhibiao Wang
- State Key Laboratory of Ultrasound Engineering in Medicine, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Lian Zhang
- College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
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27
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Management of Multiple Breast Fibroadenomas, Literature Review. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03297-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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28
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Co M, Chen C, Lee C, Yu S, Kwong A. Prospective clinical trial on the learning curve of high-intensity-focused ultrasound for the treatment of breast fibroadenoma. Surg Today 2022; 52:1048-1053. [PMID: 35000002 DOI: 10.1007/s00595-021-02421-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 10/18/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION High-intensity-focused ultrasound (HIFU) is a safe and feasible treatment option for breast fibroadenoma. However, its learning curve has not been described in the medical literature. METHODS All patients with biopsy-proven fibroadenoma considered indicated for HIFU were screened for eligibility for HIFU treatment. A total of 60 patients were recruited according to the pre-defined sample size calculation. RESULTS Sixty consecutive patients were divided into three cohorts in chronological order. The mean tumor volume shrinkage rates in cohorts 1, 2, and 3 at 6 months post-HIFU ablation were 38%, 34%, and 59%, respectively. Significant tumor shrinkage was observed from case 41 onward (p < 0.0001). Similarly, the mean tumor volume shrinkage rates in cohorts 1, 2, and 3 at 12 months post-HIFU ablation were 45%, 51%, and 71%, respectively. Significant tumor shrinkage was observed from case 41 onwards (p < 0.0473). The mean procedure time for the first 20 patients was 48.5 (range 45-75) minutes, while that in the second 20 patients was 39.7 (range 20-60) minutes, and that in the last 20 patients was 28.9 (range 15-45) minutes. The treatment time was significantly shorter from case 41 onwards (p = 0.0481). CONCLUSION Treatment outcomes and treatment time improved significantly after performing approximately 40 HIFU procedures.
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Affiliation(s)
- Michael Co
- Department of Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Clement Chen
- Department of Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Cassandra Lee
- Department of Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Stephanie Yu
- Department of Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Ava Kwong
- Department of Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China.
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29
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Satheakeerthy S, Cocker D. Can exogenous oestrogen in transitioning transgender females increase incidence of fibroadenomata? CURRENT PROBLEMS IN CANCER: CASE REPORTS 2021. [DOI: 10.1016/j.cpccr.2021.100075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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30
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Vacuum-Assisted Excision, Scarless Solution for Fibroadenoma Breast—A Single-Center Experience. Indian J Radiol Imaging 2021; 31:844-849. [PMID: 35136495 PMCID: PMC8817826 DOI: 10.1055/s-0041-1735651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background
Fibroadenoma is one of the most common benign breast lesions that is frequently surgically excised in breast practice.
Aim
The aim of this study was to determine the efficacy and safety of ultrasound-guided (USG) vacuum-assisted excision biopsy (VAEB) of fibroadenoma.
Settings and Design
A retrospective observational study.
Methods and Materials
A total of 113 patients with 163 fibroadenomas who underwent USG-guided VAEB under local anesthesia with 7G and 10G probes using an Encor Enspire equipment were included in the study. The patients were followed up after 1, 6, and 12 months. The fibroadenomas up to 4 cm were excised as per the U.S. Food and Drug Administration-approved guidelines of the American Society of Surgeons for percutaneous removal of benign breast lesions.
Results
The percentage of complete excision rate was 98.8% and the most frequent complication encountered was hematoma including immediate and delayed accounting for 3.06%. There were no recurrent lesions in our study.
Conclusion
USG-guided VAEB of benign breast lumps can be a safe and effective alternative to surgical excision and had better patient satisfaction in terms of efficacy and cosmesis.
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31
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Fujimoto A, Matsuura K, Kawasaki T, Ichinose Y, Nukui A, Hiratsuka M, Asano A, Shimada H, Osaki A, Saeki T. Early HER2-positive breast cancer arising from a fibroadenoma: a case report. Oxf Med Case Reports 2021; 2021:omab083. [PMID: 34527256 PMCID: PMC8436269 DOI: 10.1093/omcr/omab083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/11/2021] [Accepted: 07/20/2021] [Indexed: 11/23/2022] Open
Abstract
Breast cancer arising from fibroadenoma (FA) is rare, in which almost all reported cases are human epidermal growth factor receptor 2 (HER2)-negative. This is the first report to describe a case of HER2-positive breast cancer arising from FA that was treated with chemotherapy plus anti-HER2 therapy. In this early case, upfront surgery outcomes guided the selection of appropriate systemic therapy. A 31-year-old woman previously diagnosed with FA experienced tumor growth. Core needle biopsy and imaging studies confirmed a diagnosis of stage IIA HER2-positive invasive ductal carcinoma (IDC) with no evidence of lymph node metastasis (cT2N0M0). Breast-conserving surgery was performed. Pathological diagnosis revealed stage IA IDC with a predominant intraductal component (pT1aN0M0), arising from FA. In conclusion, we encountered an extremely rare case of HER2-positive breast cancer arising from FA in which pathological infiltration was difficult to predict based on preoperative imaging.
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Affiliation(s)
- Akihiro Fujimoto
- Breast Oncology Service, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Kazuo Matsuura
- Breast Oncology Service, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Tomonori Kawasaki
- Department of Pathology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Yuki Ichinose
- Breast Oncology Service, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Asami Nukui
- Breast Oncology Service, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Miyuki Hiratsuka
- Breast Oncology Service, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Aya Asano
- Breast Oncology Service, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Hiroko Shimada
- Breast Oncology Service, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Akihiko Osaki
- Breast Oncology Service, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Toshiaki Saeki
- Breast Oncology Service, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
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32
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Basara Akin I, Ozgul HA, Guray Durak M, Balci P. Evaluation of Elastographic Features in Complex Fibroadenomas With Radiologic-Pathologic Correlation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1709-1718. [PMID: 33075183 DOI: 10.1002/jum.15534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 08/31/2020] [Accepted: 09/17/2020] [Indexed: 06/11/2023]
Abstract
Fibroadenoma is the most common benign tumor of the breast, and complex fibroadenoma (CFA) is one of its variants. Of the fibroadenomas, 22% are CFAs, and in women with CFAs, the malignancy development is found to be higher than in women with noncomplex fibroadenomas. Although there is an increased risk of malignancy with CFAs, the imaging findings of CFAs are fundamentally similar to those of other variants of fibroadenomas. In the literature, B-mode ultrasound features of CFAs were reported in detail. To our knowledge, there is no study that has specifically described the elastographic findings of CFAs. This article aims to illustrate the elastographic features of CFAs and to correlate radiologic and histopathologic findings of different cases.
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Affiliation(s)
- Isil Basara Akin
- Department of Radiology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Hakan Abdullah Ozgul
- Department of Radiology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Merih Guray Durak
- Department of Radiology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Pinar Balci
- Department of Radiology, Dokuz Eylul University School of Medicine, Izmir, Turkey
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33
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Yin Lee JP, Thomas AJ, Lum SK, Shamsudin NH, Hii LW, Mai CW, Wong SF, Leong CO. Gene expression profiling of giant fibroadenomas of the breast. Surg Oncol 2021; 37:101536. [PMID: 33677364 DOI: 10.1016/j.suronc.2021.101536] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/24/2020] [Accepted: 02/24/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Fibroadenomas of the breast present as two phenotypic variants. The usual variety is 5 cm or less in diameter and there is another large variant called giant fibroadenoma which is greater than 5 cm in diameter. Despite of its large size, it is not malignant. The aim of our study is to determine whether this large variant is different from the usual fibroadenoma in terms of its biological pathways and biomarkers. METHODS mRNA was extracted from 44 fibroadenomas and 36 giant fibroadenomas, and transcriptomic profiling was performed to identify up- and down-regulated genes in the giant fibroadenomas as compared to the fibroadenomas. RESULTS A total of 40 genes were significantly up-regulated and 18 genes were significantly down-regulated in the giant fibroadenomas as compared to the fibroadenomas of the breast. The top 5 up-regulated genes were FN1, IL3, CDC6, FGF8 and BMP8A. The top 5 down-regulated genes were TNR, CDKN2A, COL5A1, THBS4 and BMPR1B. The differentially expressed genes (DEGs) were found to be associated with 5 major canonical pathways involved in cell growth (PI3K-AKT, cell cycle regulation, WNT, and RAS signalling) and immune response (JAK-STAT signalling). Further analyses using 3 supervised learning algorithms identified an 8-gene signature (FN1, CDC6, IL23A, CCNA1, MCM4, FLT1, FGF22 and COL5A1) that could distinguish giant fibroadenomas from fibroadenomas with high predictive accuracy. CONCLUSION Our findings demonstrated that the giant fibroadenomas are biologically distinct to fibroadenomas of the breast with overexpression of genes involved in the regulation of cell growth and immune response.
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Affiliation(s)
- June Pui Yin Lee
- School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | | | - Siew Kheong Lum
- School of Medicine, International Medical University, Kuala Lumpur, Malaysia.
| | | | - Ling-Wei Hii
- Center for Cancer and Stem Cell Research, Institute for Research, Development and Innovation (IRDI), International Medical University, Kuala Lumpur, Malaysia; School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia; School of Postgraduate Studies, International Medical University, Kuala Lumpur, Malaysia
| | - Chun-Wai Mai
- Center for Cancer and Stem Cell Research, Institute for Research, Development and Innovation (IRDI), International Medical University, Kuala Lumpur, Malaysia; School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
| | - Shew-Fung Wong
- School of Medicine, International Medical University, Kuala Lumpur, Malaysia; Center for Environmental and Population Health, Institute for Research, Development and Innovation (IRDI), International Medical University, Kuala Lumpur, Malaysia
| | - Chee-Onn Leong
- Center for Cancer and Stem Cell Research, Institute for Research, Development and Innovation (IRDI), International Medical University, Kuala Lumpur, Malaysia; School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia.
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34
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Jena S, Sinha NK. Use of Lateral Oncoplasty for Multiquadrant Giant Fibroadenoma: A Novel Approach. Cureus 2021; 13:e15090. [PMID: 34155459 PMCID: PMC8210705 DOI: 10.7759/cureus.15090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Giant fibroadenomas are uncommon benign lesions, defined as fibroadenomas of >5 cm in size and/or weighing more than 500 g. They can distort the shape of the breast and cause asymmetry, so they should be excised. Here, we report two cases of giant fibroadenoma, where wide local excision and reconstruction with lateral oncoplasty were done. Compared to all previous reports of patients with giant fibroadenoma, where the lump was excised either through a submammary incision or by round block technique depending on the location of the tumour, we used the lateral oncoplasty technique in both patients. Lateral oncoplasty is a new reconstructive option to maintain cosmesis and symmetry after the excision of giant fibroadenomas in the outer and central quadrants of the breast. It is a good option for reconstruction in cases where the defect is very large and facilities for conventional flap surgeries are not available.
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Feliciano YZ, Freire R, Net J, Yepes M. Ductal and lobular carcinoma in situ arising within an enlarging biopsy proven fibroadenoma. BMJ Case Rep 2021; 14:e237017. [PMID: 33468635 PMCID: PMC7817826 DOI: 10.1136/bcr-2020-237017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 01/21/2023] Open
Abstract
The diagnosis via core needle biopsy of concurrent ductal carcinoma in situ and lobular carcinoma in situ within an enlarging previously biopsied benign fibroadenoma in women in their 40s is rare. Several case reports have described the occurrence of malignant changes within fibroadenomas, usually as an incidental finding following excision, and few reports have documented the transition of a fibroadenoma to malignancy. The current case report emphasises the importance of re-biopsying enlarging fibroadenomas, even with otherwise maintained benign appearing features on imaging, in women in their 40s, in order to exclude the possibility of malignancy.
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MESH Headings
- Biopsy, Large-Core Needle
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/therapy
- Carcinoma, Lobular/diagnostic imaging
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/therapy
- Female
- Fibroadenoma/pathology
- Humans
- Mammography
- Middle Aged
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Affiliation(s)
- Yara Z Feliciano
- Radiology Department, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Rochelle Freire
- Pathology Department, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jose Net
- Radiology Department, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Monica Yepes
- Radiology Department, University of Miami Miller School of Medicine, Miami, Florida, USA
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Nigam JS, Tewari P, Prasad T, Kumar T, Kumar A. Carcinoma Breast-Like Giant Complex Fibroadenoma: A Clinical Masquerade. Cureus 2021; 13:e12611. [PMID: 33585101 PMCID: PMC7872482 DOI: 10.7759/cureus.12611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Fibroadenoma (FA) is a benign, painless, solid breast tumor that commonly occurs in young adult females. The term complex FA is used when it is associated with any of the following: cyst >3 mm, epithelial calcifications, sclerosing adenosis, or papillary apocrine metaplasia. FAs of size more than 5 cm or weighing more than 500 g are considered as giant FAs. Giant FAs are rare, and because of hormonal sensitivity, they commonly occur in pregnant or lactating women. We report the case of a 26-year-old female with a large breast mass that was clinically as well as grossly masquerading as breast carcinoma and turned out to be a giant complex FA on microscopy.
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Affiliation(s)
- Jitendra S Nigam
- Pathology/Lab Medicine, All India Institute of Medical Sciences, Patna, IND
| | - Prerna Tewari
- Pathology/Lab Medicine, All India Institute of Medical Sciences, Patna, IND
| | - Tanya Prasad
- Pathology/Lab Medicine, All India Institute of Medical Sciences, Patna, IND
| | - Tarun Kumar
- Pathology/Lab Medicine, All India Institute of Medical Sciences, Patna, IND
| | - Anil Kumar
- Surgery, All India Institute of Medical Sciences, Patna, IND
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Kabuyaya MK, Mutombo FL, Moseka FM, Kihemba K, Wetzig N, Lussy JP. A giant fibroadenoma in a mature woman: diagnosis and treatment in a limited resource environment (a case report). Pan Afr Med J 2021; 38:19. [PMID: 34650650 PMCID: PMC8488286 DOI: 10.11604/pamj.2021.38.19.26200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/08/2020] [Indexed: 11/11/2022] Open
Abstract
We report an extremely rare case of a 40-year-old woman with a giant fibroadenoma of 30cm in diameter that was accompanied by ulceration and bleeding. We document the onset, the clinical presentation, as well as the challenge encountered in the diagnosis and managing in a limited resource environment.
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Affiliation(s)
- Médard Kakule Kabuyaya
- Department of Surgery, HEAL Africa Tertiary Hospital, Goma, Democratic Republic of Congo
- Department of Surgery, University of Goma (UNIGOM), Goma, Democratic Republic of Congo
| | - Fabrice Lele Mutombo
- Department of Surgery, HEAL Africa Tertiary Hospital, Goma, Democratic Republic of Congo
| | | | - Kasereka Kihemba
- Department of Pathology, HEAL Africa Tertiary Hospital, Goma, Democratic Republic of Congo
| | - Neil Wetzig
- Department of Surgery, HEAL Africa Tertiary Hospital, Goma, Democratic Republic of Congo
| | - Justin Paluku Lussy
- Department of Gynecology and Obstetrics, HEAL Africa Tertiary Hospital, Goma, Democratic Republic of Congo
- Department of Obstetrics and Gynecology, University of Goma (UNIGOM), Goma, Democratic Republic of Congo
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Yılmaz S, Aykota MR, Arman Karakaya Y, Özgen U, Erdem E. Phyllodes Tumors of the Breast: A Single-Center Experience. Eur J Breast Health 2020; 17:36-41. [PMID: 33796829 DOI: 10.4274/ejbh.2020.5961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 08/29/2020] [Indexed: 12/01/2022]
Abstract
Objective We aimed to analyze the clinicopathological findings, treatment approach, and treatmen outcomes in patients diagnosed with phyllodes tumor (PT). Materials and Methods The clinicopathological data of 26 patients with PT, who were treated between 2008 and 2019, were retrospectively analyzed. Results Mean age was 35.07±13.95 years (range: 14-71), while mean tumor size was 54.76±29.24 mm (range: 25-135). Benign, borderline, and malignant PT were detected in 18 (69.2%), 3 (11.5%), and 5 (19.2%) patients, respectively. Marginless excision was performed in 20 patients (76.9%), while six (23.1%) patients underwent mastectomy. A statistically significant correlation of tumor type with mean tumor size and mean age was observed (p=0.041 and p=0.013, respectively). Margin positivity on first excision was more frequent in the malignant tumors (p=0.02). No statistically significant correlation of PT type with presence of breast cancer in the family history, and tumor localization was observed (p=0.79 and p=0.13, respectively). Mean postoperative follow-up duration was 56 months (range: 6-147). Local recurrence was not observed in any of the patients. Lung and left vastus lateralis muscle metastases were encountered. The patient with lung metastasis became exitus because of the same reason 6 months after detection of the metastasis. Conclusion PT is a rare fibroepithelial tumor of the breast that is characterized by a mixed histology seen in younger ages when compared to the classical breast tumors. The probability of PT should be considered in the presence of a rapid-growing mass in the breast. In addition, it should also be considered that the contribution of imaging techniques may be limited.
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Affiliation(s)
- Sevda Yılmaz
- Department of General Surgery, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Muhammed Rasid Aykota
- Department of General Surgery, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Yeliz Arman Karakaya
- Department of Pathology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Utku Özgen
- Department of General Surgery, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Ergün Erdem
- Department of General Surgery, Pamukkale University Faculty of Medicine, Denizli, Turkey
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39
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Fibroadenomas: a multidisciplinary review of the variants. Clin Imaging 2020; 71:83-100. [PMID: 33186871 DOI: 10.1016/j.clinimag.2020.10.058] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/02/2020] [Accepted: 10/26/2020] [Indexed: 11/21/2022]
Abstract
Fibroadenomas are the most common benign breast lesions in women. Hormonal activities, particularly an increase in oestrogenic activity, have an important role in the aetiology of fibroadenomas. They are commonly detected incidentally. Most fibroadenomas have similar imaging findings and these lesions can be defined as simple fibroadenomas (SFAs). However, due to different histopathologic characteristics and components, variants of fibroadenomas have been described. These variants include; juvenile, giant, complex, myxoid, cellular, and hyalinised fibroadenomas. The diagnoses of these variants are important. They have different clinical behaviours, potential for malignant transformation, and treatment strategies. We present imaging findings of SFAs and other variants of fibroadenomas. To our knowledge, there is no review in which imaging findings of all fibroadenoma variants are presented together.
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Basara Akin I, Ozgul H, Simsek K, Altay C, Secil M, Balci P. Texture Analysis of Ultrasound Images to Differentiate Simple Fibroadenomas From Complex Fibroadenomas and Benign Phyllodes Tumors. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1993-2003. [PMID: 32329531 DOI: 10.1002/jum.15304] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/15/2020] [Accepted: 03/26/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) category 4A lesions can be distinguished from BI-RADS 3 lesions with main ultrasound (US) findings such as a well-defined contour, round/oval shape, and parallel orientation with a homogeneous echo pattern. Breast Imaging Reporting and Data System 4A solid masses might be diagnosed as simple fibroadenomas (SFAs), complex fibroadenomas (CFAs), or benign phyllodes tumors (BPTs). Complex fibroadenomas have an increased risk of invasive cancer development than SFAs, and BPTs have a risk of borderline-malignant phyllodes tumor transformation; both of them are surgically treated, whereas follow-up procedures are applied in SFAs. It is essential to differentiate SFAs from CFAs and BPTs. Grayscale features of these lesions include a prominent overlap. Texture analyses in breast lesions have contributions in benign-malignant lesion differentiation. In this study, we aimed to use texture analysis of US images to differentiate these benign lesions. METHODS Grayscale US features of lesions (32 SFAs, 31 CFAs, and 32 BPTs) were classified according to the BI-RADS. Texture analysis of US images with LIFEx software (http://www.lifexsoft.org) was performed retrospectively. First- and second-order histogram parameters were evaluated. RESULTS In grayscale US, the shape, orientation, and posterior acoustic characteristics had statistical significance (P < .05). In the statistical analysis, skewness, kurtosis, excess kurtosis, gray-level co-occurrence matrix (GLCM)-energy, GLCM-entropy log 2, and GLCM-entropy log 10 revealed significant differences among all 3 groups (P < .05). CONCLUSIONS As grayscale US features show prominent intersections, and treatment options differ, correct diagnosis is essential in SFAs, CFAs, and BPTs. In this study, we concluded that texture analysis of US images can discriminate SFAs from CFAs and BPTs. Texture analyses of US images is a potential candidate diagnostic tool for these lesions, and accurate diagnoses will preclude patients from undergoing unnecessary biopsies.
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Affiliation(s)
- Isil Basara Akin
- Department of Radiology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Hakan Ozgul
- Department of Radiology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Kursat Simsek
- Department of Radiology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Canan Altay
- Department of Radiology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Mustafa Secil
- Department of Radiology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Pinar Balci
- Department of Radiology, Dokuz Eylul University School of Medicine, Izmir, Turkey
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41
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Zmora O, Klin B, Iacob C, Meital A, Mendlovic S, Karni T. Characterizing excised breast masses in children and adolescents-Can a more aggressive pathology be predicted? J Pediatr Surg 2020; 55:2197-2200. [PMID: 32061367 DOI: 10.1016/j.jpedsurg.2020.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/22/2019] [Accepted: 01/14/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Our aim was to characterize excised breast masses in children and adolescent and to identify factors associated with a more aggressive pathology. METHODS Retrospective review of all female patients <19 who underwent excision of breast masses at our institution between 1999 and 2018. Demographic, clinical, imaging, pathological and management data were collected. We assessed possible association of any of the variables with a more aggressive pathology (phyllodes tumor and malignancy). Correlation between core needle biopsy results and final pathology results was also calculated. RESULTS 70 patients were included. Median age was 17 years (range: 11-19). Resected mass size was 4 cm (range: 2-16). Final pathology results were: fibroadenoma (49), juvenile fibroadenoma (7), hamartoma (5), benign phyllodes (7), malignant phyllodes (1) and sarcoma (1). Pathology was benign in 61 (87%) patients and more aggressive (phyllodes and sarcoma) in 9 (13%). None of the tested variables was associated with a more aggressive pathology. Presurgical core biopsy results matched final pathology in only 63.6%. CONCLUSIONS Excised breast masses in children and adolescents are sometimes of a more aggressive pathology, which cannot be predicted by presurgical factors, including a core needle biopsy. Prognosis study LEVEL OF EVIDENCE: III.
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Affiliation(s)
- Osnat Zmora
- Department of Pediatric Surgery, Shamir (Assaf Harofeh) Medical Center, Zerifin, Be'er Ya'akov, Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Baruch Klin
- Department of Pediatric Surgery, Shamir (Assaf Harofeh) Medical Center, Zerifin, Be'er Ya'akov, Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Catalin Iacob
- Department of Pediatric Surgery, Shamir (Assaf Harofeh) Medical Center, Zerifin, Be'er Ya'akov, Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aaron Meital
- Department of Pediatric Surgery, Shamir (Assaf Harofeh) Medical Center, Zerifin, Be'er Ya'akov, Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sonia Mendlovic
- Department of Pathology, Shamir (Assafh Harofeh) Medical Center, Zerifin, Be'er Ya'akov, Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tami Karni
- Department of General Surgery, Shamir (Assaf Harofeh) Medical Center, Zerifin, Be'er Ya'akov, Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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42
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Core needle biopsy diagnosis of fibroepithelial lesions of the breast: a diagnostic challenge. Pathology 2020; 52:627-634. [PMID: 32771211 DOI: 10.1016/j.pathol.2020.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/18/2020] [Accepted: 06/25/2020] [Indexed: 12/25/2022]
Abstract
Fibroepithelial lesions (FEL) of the breast are biphasic neoplasms consisting of proliferative epithelial and stromal components and include fibroadenoma, phyllodes tumour and periductal stromal tumour. Core needle biopsy (CNB) is a commonly used diagnostic modality for investigation of breast lesions. As the accurate diagnosis of FEL requires integrated assessment of both epithelial and stromal components, this may create problems in small biopsies with limited sampling. In this review, common problems encountered in CNB of FEL are discussed, including establishing a diagnosis of borderline/malignant phyllodes tumour in a biopsy consisting of malignant spindle cells, differentiating phyllodes tumour from fibroadenoma on CNB, grading of phyllodes tumour of intermediate histological grade and assessment of periductal stromal tumours. The approaches are detailed systematically based on histology, immunohistochemistry and molecular characterisation. This comprehensive approach may aid in dealing with the overlapping histological appearance of FEL and sampling limitations of CNB.
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43
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Ching D, Pirasteh S, Vora B, Martin R, Gill J. Malignant fibroadenoma with CHEK2 mutation: a novel case. Pathology 2020; 52:599-601. [PMID: 32605861 DOI: 10.1016/j.pathol.2020.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 04/08/2020] [Accepted: 04/14/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Daniel Ching
- Western Diagnostics Pathology, Myaree, Perth, WA, Australia.
| | - Shadi Pirasteh
- Western Diagnostics Pathology, Myaree, Perth, WA, Australia
| | - Bhavya Vora
- King Edward Memorial Hospital, Subiaco, Perth, WA, Australia
| | - Richard Martin
- Mr Richard Martin General Surgery Subiaco, Subiaco, Perth, WA, Australia
| | - Jespal Gill
- Western Diagnostics Pathology, Myaree, Perth, WA, Australia
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44
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El-Essawy M, AL Haidary A, Khan AL. Ductal carcinoma in situ (DCIS) in breast fibroadenoma. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00191-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background
Fibroadenoma is the most common benign tumor; although malignant, changes are rare. Any changes or increase in size should be evaluated thoroughly to exclude any malignant formation.
Case presentation
A 25-year-old female presenting to our department complaining of enlargement of the previously stable mass underwent imaging assessment and biopsy which revealed ductal carcinoma in situ changes developed in a fibroadenoma.
Conclusion
Although malignant changes in a fibroadenoma are rare, biopsy of increasing size fibroadenoma is advised to avoid missing any malignant changes; the incidence is more in the complex fibroadenoma.
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45
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Ultrasound-guided percutaneous microwave ablation for 755 benign breast lesions: a prospective multicenter study. Eur Radiol 2020; 30:5029-5038. [DOI: 10.1007/s00330-020-06868-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 03/13/2020] [Accepted: 04/06/2020] [Indexed: 02/03/2023]
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46
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Cohen O, Avinadav E, Sharon E, Pirogovsky A, Freud E. Pediatric and Adolescent Surgical Breast Clinic: Preliminary Experience. J Pediatr Adolesc Gynecol 2020; 33:23-26. [PMID: 31445140 DOI: 10.1016/j.jpag.2019.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/03/2019] [Accepted: 08/15/2019] [Indexed: 02/05/2023]
Abstract
STUDY OBJECTIVE The diagnostic and treatment tools used in breast centers are largely geared to adults, and there is little consideration of the unique characteristics of breast diseases in younger age groups. Herein we report on the preliminary experience of a specialized breast clinic for children and adolescents. DESIGN Retrospective, observational. SETTING Pediatric Surgical Breast Clinic of Schneider Children's Medical Center of Israel. PARTICIPANTS Patients referred to the clinic during the first 18 months of its establishment. INTERVENTIONS AND MAIN OUTCOME MEASURES Rate of breast masses, rate of malignancy, and types of evaluation and treatment. RESULTS Forty-seven patients aged 0-19 years were referred. Breast masses were suspected in 23/47 (48.9%) and confirmed using ultrasound in 14/47 (29.7%; mean age, 16.4 years), followed by needle core biopsy in 7. Seven patients had multiple masses. Breast Imaging and Reporting Data System scores ranged from 3 to 4b. All cases were treated as fibroadenomas. Four patients underwent surgery because of a large mass (>5 cm; n = 3) or patient's preference to remove the lump rather than follow-up (n = 1). There were no malignancies. The median time from patient identification of the mass until seeking medical help was 5 months. CONCLUSION Several findings distinct to this age group were highlighted: high rate of multiple masses, lack of malignancy, and high risk of delayed diagnosis. Care should be taken when using Breast Imaging and Reporting Data System categorization because it was formulated for adults and might be very limited in the adolescent population. Longer-term studies of larger cohorts are planned.
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Affiliation(s)
- Osher Cohen
- Departments of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Efrat Avinadav
- Departments of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Sharon
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Avinoam Pirogovsky
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Medical Management, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Enrique Freud
- Departments of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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47
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Brenin DR, Patrie J, Nguyen J, Rochman CM. Treatment of Breast Fibroadenoma with Ultrasound-Guided High-Intensity Focused Ultrasound Ablation: A Feasibility Study. JOURNAL OF BREAST IMAGING 2019; 1:316-323. [PMID: 38424803 DOI: 10.1093/jbi/wbz050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Breast fibroadenomas (FAs) are common, benign, and often bothersome. Current management includes observation or surgical excision. This study evaluated the safety and feasibility of ultrasound-guided high-intensity focused ultrasound ablation for the treatment of FAs. METHODS Twenty women with a palpable, biopsy-confirmed FA were enrolled in a prospective trial, and they underwent treatment utilizing an ultrasound-guided high-intensity focused ultrasound ablation device. Tumors were greater than 1 cm in diameter, with volumes of 0.3-10 cc. Safety, treatment experience, toxicity, cosmesis, and change in tumor size on palpation and ultrasound measurement were obtained before and after treatment at 3, 6, and 12 months. RESULTS All of the 20 patients completed therapy. Pretreatment mean tumor volume was 1.8 cc (standard deviation = 1.23, range 0.57-5.7). Half of the patients reported a painful mass before treatment. All adverse events were well tolerated and transient, with the most common being mild pain, reported by 15 of 20 patients during treatment, and 14 of 20 at the day-7 postprocedure follow-up. Mean pain score during treatment was 16, and at day 7, it was 12.2, on a scale from 0 to 100 (100 = worst pain). Mean patient satisfaction was 4.4 on a scale of 1-5 (5 = most satisfied). Mean likelihood of recommending treatment was 4.7 (5 = most likely). At the 12-month postprocedure follow-up, the mean reduction in volume of the FA was 65.5% on ultrasound; the mass was no longer palpable in 80% of the patients; no patients reported pain; and cosmesis was rated as excellent in all patients. CONCLUSION Ultrasound-guided high-intensity focused ultrasound ablation appears to be effective, safe, and well tolerated for the treatment of FAs. A larger multicenter clinical trial is currently under way.
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Affiliation(s)
- David R Brenin
- University of Virginia Health System, Department of Surgery, Charlottesville, VA
| | - James Patrie
- University of Virginia Health System, Department of Public Health Sciences, Charlottesville, VA
| | - Jonathan Nguyen
- University of Virginia Health System, Department of Public Health Sciences, Charlottesville, VA
| | - Carrie M Rochman
- University of Virginia Health System, Department of Radiology, Charlottesville, VA
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Saadallah F, Bouraoui I, Naija L, Sakhri S, Zemni I, Hassouna JB, Dhieb TB, Bouzaiene H, Rahal K. Coexistence of invasive ductal breast carcinoma and fibroadenoma. Pan Afr Med J 2019; 33:139. [PMID: 31558937 PMCID: PMC6754844 DOI: 10.11604/pamj.2019.33.139.17140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/28/2018] [Indexed: 11/11/2022] Open
Abstract
Fibroadenomas are the most common breast disease that occurs usually in young. The coexistence of an invasive ductal carcinoma and a fibroadenoma in the ipsilateral breast is extremely rare. We present the case of a 52 years woman, presented to us for an upper-outer breast lump. Breast imaging concluded to tow contiguous lesions, one of them was suspicious. She had a conservative surgery. Histology concluded to a fibroadenoma and an invasive ductal carcinoma.
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Affiliation(s)
- Fatma Saadallah
- Department of Surgical Oncology, Salah Azaiz Anti-cancer Institute, Tunis, Tunisia
| | - Imen Bouraoui
- Department of Surgical Oncology, Salah Azaiz Anti-cancer Institute, Tunis, Tunisia
| | - Lamia Naija
- Department of Surgical Oncology, Salah Azaiz Anti-cancer Institute, Tunis, Tunisia
| | - Saida Sakhri
- Department of Surgical Oncology, Salah Azaiz Anti-cancer Institute, Tunis, Tunisia
| | - Ines Zemni
- Department of Surgical Oncology, Salah Azaiz Anti-cancer Institute, Tunis, Tunisia
| | - Jamel Ben Hassouna
- Department of Surgical Oncology, Salah Azaiz Anti-cancer Institute, Tunis, Tunisia
| | - Tarak Ben Dhieb
- Department of Surgical Oncology, Salah Azaiz Anti-cancer Institute, Tunis, Tunisia
| | - Hatem Bouzaiene
- Department of Surgical Oncology, Salah Azaiz Anti-cancer Institute, Tunis, Tunisia
| | - Khaled Rahal
- Department of Surgical Oncology, Salah Azaiz Anti-cancer Institute, Tunis, Tunisia
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49
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Meng X, Yamanouchi K, Kuba S, Sakimura C, Morita M, Matsuguma K, Kanetaka K, Takatsuki M, Abe K, Eguchi S. Giant fibroadenoma of the breast: A rare case in a mature woman. Int J Surg Case Rep 2019; 63:36-39. [PMID: 31561187 PMCID: PMC6796725 DOI: 10.1016/j.ijscr.2019.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/31/2019] [Accepted: 09/09/2019] [Indexed: 11/16/2022] Open
Abstract
We experienced giant fibroadenoma of breast, a rare case in a mature woman. We suspected a malignant tumor, due to the size and ulceration and bleeding. Total mastectomy and skin grafting were needed for complete resection. An early diagnosis and treatment could prevent total mastectomy.
Introduction Fibroadenomas are common benign lesions of the breast that are usually found young patients. Giant fibroadenomas are uncommon benign lesions, defined as fibroadenomas of >5 cm in size, which are usually found in patients of less than 20 years of age. Presentation of case A 39-year-old premenopausal woman presented with a right breast tumor that had rapidly increased in size and which showed ulceration and bleeding. Needle biopsy showed mixed connective tissue and an epithelial tumor without a leaf-like pattern, but indeterminate. Total mastectomy and skin grafting were performed. Histopathology confirmed the diagnosis of giant fibroadenoma. Discussion In comparison to all previous reports on patients with giant fibroadenoma, this patient was relatively old and the etiology was unknown. Although rare, an appropriate therapeutic strategy should be decided according to the results of a histopathological examination. Conclusion Early treatment could allow breast preserving surgery and patients should be recommended to undergo reexamination with awareness of progression.
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Affiliation(s)
- Xiangyue Meng
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Kosho Yamanouchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
| | - Sayaka Kuba
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Chika Sakimura
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Michi Morita
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Kunihito Matsuguma
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Kengo Kanetaka
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Mitsuhisa Takatsuki
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Kuniko Abe
- Department of Pathology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan; Department of Pathology, Nagasaki Genbaku (Atomic Bomb) Hospital, 3-15 Mori-machi, Nagasaki, 852-8511, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
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Dialani V, Chansakul T, Lai KC, Gilmore H, Sayegh NY, Slanetz PJ. Enlarging biopsy-proven fibroadenoma: Is surgical excision necessary? Clin Imaging 2019; 57:35-39. [DOI: 10.1016/j.clinimag.2019.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 03/08/2019] [Accepted: 03/26/2019] [Indexed: 11/26/2022]
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