Radiology -- eLetters for Gordon et al., 229 (1) 233-238

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Breast Imaging:
Paula B. Gordon, Faith A. Gagnon, and Leora Lanzkowsky
Solid Breast Masses Diagnosed as Fibroadenoma at Fine-Needle Aspiration Biopsy: Acceptable Rates of Growth at Long-term Follow-up
Radiology 2003; 229: 233-238 [Abstract] [Full text] [PDF]

eLetters: Submit a response to this article

Electronic letters published:

Should Fibroadenomas Be Followed Up?: Stefano Ciatto, MD (5 January 2004)

Should Fibroadenomas Be Followed Up? 5 January 2004

Stefano Ciatto, MD,
radiologist
Centro per lo Studioe la Prevenzione Oncologica, Florence, Italy
Send letter to journal:
Re: Should Fibroadenomas Be Followed Up?

s.ciatto{at}cspo.it Stefano Ciatto, MD

Editor:
In their conclusion, Gordon and colleagues suggest that masses diagnosed as fibroadenomas at fine-needle aspiration biopsy (FNAB) should be followed-up with ultrasonographic (US) measurement to assess their growth rate to identify (fast-growing) misdiagnosed cancers (1). Apart from questioning the specificity of FNAB in diagnosing fibroadenoma, rather than simply (and more reliably) providing just a "negative" report, I believe that immediate core biopsy would provide definitive (accuracy is greater than 99%) proof of fibroadenoma and would probably cost no more (if not less--costs may vary by country) compared with immediate FNAB and repeat US follow-up to assess growth rate. Moreover, histologic diagnosis at core biopsy would end the diagnostic process and would reduce the anxiety of the patient, who is aware that her breast harbors a lesion worthy of close follow-up and that she must wait 6 months for a final diagnosis (if any). In the majority of cases, the diagnosis of fibroadenoma at palpation, imaging, and FNAB is highly reliable, and the lesion needs no special follow-up and may be safely followed up (if palpable) with breast self-examination. In cases with even a minimal possibility of malignancy, immediate core biopsy is a faster, probably cheaper, and definitely more reliable approach than US follow-up to assess growth rate.
Reference
1. Gordon PB, Gagnon FA, Lanzkowsky L. Solid Breast Masses Diagnosed as Fibroadenoma at Fine-Needle Aspiration Biopsy: Acceptable Rates of Growth at Long-term Follow-up. Radiology 2003; 229:233-238.
Drs Gordon, Gagnon, and Lanzkowsky respond:
Thank you for the opportunity to respond to Dr Ciatto's letter. The points he raises are valid. In most cases, immediate large-core needle biopsy (LCNB) would obviate imaging follow-up for solid masses diagnosed as fibroadenomas at histology. Indeed, in many areas LNCB is becoming the standard of care. This was not the case during the time period that the patient data were collected for this report and is still not currently the case in British Columbia.
Dr Ciatto suggests an accuracy rate of greater than 99% for LCNB. This is not substantially different from our accuracy with FNAB, when the imaging characteristics are included with the cytology results in making the diagnosis of fibroadenoma. But if a palpable fibroadenoma enlarges after LCNB or a nonpalpable fibroadenoma is seen to enlarge at subsequent screening mammography, suddenly "greater than 99%" sounds less than perfect and can cause anxiety for both patients and their physicians. Thus, even though the false-negative rate with LCNB, as with FNAB, is minuscule, follow-up is suggested for the reasons given in our report.
Fibroadenomas usually remain stable or decrease in size at follow-up, but for the few that do enlarge, we believe that it is important to have a rate of growth known to be safe to follow. Our goal was to offer a growth-rate range that would provide confidence when suggesting and accepting surveillance for these patients.