Experts share new recommendations for managing benign breast lesions
This week, a group of experts published detailed new recommendations related to the management of benign fibroepithelial lesions identified on imaging.
The guidelines are a collaboration between the American Society of Breast Surgeons and the Society of Breast Imaging. The duo worked together to create the guidelines due to a lack of evidence- and consensus-based guidelines for the management of benign breast disease.
Such disease is extremely common, with some studies estimating that up to 80% of breast lumps are benign. These lumps can be challenging for providers to oversee, as it is necessary to rule out cancer, but the exams and procedures required to do so are often invasive in nature.
“These guidelines provide clarification on the controversial management of benign [fibroepithelial lesions] of the breast,” Laura H. Rosenberger, MD, MS, from the department of surgery at Duke University Health System, and colleagues noted. “Any practicing clinicians who treat patients with benign [fibroepithelial lesions] should integrate these guidelines into treatment of their patients.”
The new recommendations are as follows:
Excision is recommended for core biopsy-proven, concordant fibroadenomas without atypia only if they are causing symptoms, above a certain size, have grown substantially between exams or if the patient has requested removal.
For fibroadenomas being removed, the group suggests complete excision without transection of the mass. Prior to these removals, surgeons should carefully consider aesthetics and sensation when determining excision location.
Core biopsy-proven fibroadenomas do not require imaging follow-up. Patients may resume routine age-recommended imaging once this has been determined.
Benign phyllodes tumors often present as fibroepithelial lesions on biopsy, but if there is suspicion the these may be a phyllodes tumor, surgical biopsy with complete excision of the mass is recommended.
Positive margins typically will not require re-excision. However, a margin re-excision may be considered if the mass was transected or there is a chance of lingering residual disease after excisional biopsy.
Patients who have had an excisional biopsy do not require additional imaging and may resume routine age-appropriate screening intervals.
Read more about the new guidelines here (behind paywall).
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.