An audit reviewing the management of fibroadenomas with the advent of Mammotome in the breast unit in Bradford

Abstract

Fibroadenomas are the commonest benign breast tumours. Prior to vacuum-assisted large-volume biopsy, surgical excision was the only therapeutic option available. Our unit introduced Mammotome (Ethicon Endo-Surgery, Cincinnati, OH, USA) in January 2006, with Mammotome excision offered from September 2006 (for lesions 25 mm or less). We reviewed the change in practice with the advent of Mammotome. Patients with histological diagnosis of fibroadenoma throughout 2006 and 2007 were identified. The radiology and histology were reviewed. A total of 355 fibroadenomas were diagnosed in 333 patients: 252 presented symptomatically, 81 were screen-detected. Thirty-five diagnostic Mammotomes were performed (33 had been nondiagnostic on needle-core biopsy, two had radiology/pathology discordance). Definitive diagnosis was consequently made in 34 cases. One patient with nondiagnostic Mammotome had subsequent surgical biopsy of benign fibroadenoma. Seventy patients underwent excision. Fifteen were ultrasound Mammotome excisions; 13 confirmed fibroadenoma and two were phylloides (having surgical cavity excision subsequently). Fifty-five were surgical excisions; 33 were either unsuitable for Mammotome excision or the patient chose surgery; 11 were B2/B3 lesions and pathology recommended surgical excision; and the remaining 11 were before the introduction of Mammotome excision. Mammotome offers patient choice regarding excision of fibroadenomas, and reduces the number of surgical biopsies.