Fibroadenoma of the breast is a common benign lesion, affecting women during their reproductive years. Despite there benignity, they can cause physical deformity due to large size and may produce discomfort or emotional distress in afflicted individuals. The traditional management options available to women diagnosed with a fibroadenoma include observation or surgical excision. Two newer approaches, percutaneous excision and in-situ cryoablation, have been developed and are less invasive than surgical excision. The purpose of this consensus statement is to put these four management options into perspective for our members and their patients.

      In most patients with fibroadenoma(s), the ideal approach is confirmation with percutaneous core biopsy and conservative follow-up. Because the malignant potential of fibroadenomas is extremely low, treatment is not required on an oncologic basis. This conservative approach is the least costly in terms of dollars and morbidity. About 50% of fibroadenomas will disappear in 5 years, with remaining lesions either increasing in size or remaining unchanged.

      Because fibroadenomas can be bothersome to some patients, causing physical deformity, discomfort, or emotional distress as above, most breast surgeons will respect an informed patient's preference for treatment. Traditional open excisional biopsy is effective treatment in such cases, but it is the most costly option because of the operating room charges and time off from work. Open excision may still be the best option in some cases, based on large size of the fibroadenoma or the judgment of the surgeon.

      Recently a large multi-center study has shown that ultrasound-guided percutaneous excision of palpable fibroadenomas with a vacuum assisted core biopsy device is safe, effective, and well tolerated by patients. For women who prefer removal of the lesion, this procedure offers minimal morbidity, cost, time off from work, and cosmetic impact.

      Several multi-institutional trials have demonstrated cryoablation to be a successful option for the resolution of fibroadenomas without surgical excision. The Food and Drug Administration has approved the use of cryoablation as a safe and effective therapy for fibroadenomas. The technique of cryoablation involves ultrasound guidance for three-dimensional probe placement within the center of the fibroadenoma. Physicians practicing this technique and/or percutaneous excisional biopsy should be appropriately skilled in breast ultrasound is recommended by the American Society of Breast Surgeons.

Approved, September 21, 2004 Board of Directors The American Society of Breast Surgeons.