Definition & Overview

A fibroadenoma is a noncancerous tumour that develops in the breasts. Although it usually affects women between the ages of 20 and 30, it can occur in women of any age. At the onset, the tumour is about the size of a pea and can hardly be felt. However, it can grow to the size of a marble and can cause discomfort or even breast deformity.

Fibroadenomas may not be cancerous, but they increase the patients' risk of developing cancer. As such, doctors recommend their removal. Traditionally, fibroadenomas were removed through surgical excision. However, technological developments have led to a relatively new procedure called ultrasound-guided cryosurgical ablation. The procedure is also called cryoablation or cryosurgery.

Ultrasound-guided cryosurgical ablation is minimally invasive and is relatively simple to perform. The concept is to freeze the tumour to prevent it from growing. In time, the tumour breaks down and is absorbed and released by the body.

According to statistics, cryoablation has a high rate of success. In fact, studies suggest that the procedure has become the primary choice for fibroadenoma ablation. Additionally, studies have proven that the procedure does not result in any significant complication. It can be completed in 30 minutes, depending on the number and location of fibroadenomas.

Who Should Undergo & Expected Results

Depending on the size, a fibroadenoma can be felt through the skin. However, in most cases, the tumour is discovered through breast cancer screening that uses mammography or ultrasonography.

The physical appearance of the tumour is usually enough to diagnose it as a noncancerous fibroadenoma. However, there are cases wherein a doctor may not be certain. In such cases, a biopsy may be requested to confirm the diagnosis.

Women who have a high risk of breast cancer, or are simply concerned about developing one, should undergo regular breast cancer screening. There are also women who know how to perform self-examination of the breast. If they feel an unusual lump in the skin, they are advised to have it diagnosed.

Once the doctor confirms that the tumour is indeed a fibroadenoma, its removal will likely be recommended. If the clinic has the necessary equipment to perform cryoablation, the procedure can be included in the recommendation.

Although cryoablation is highly recommended, the procedure is not for everybody. According to the American Society of Breast Surgeons, cryoablation should only be performed on fibroadenomas that have a circumference of 4 cm or less.

How Does the Procedure Work?

Before the procedure, the doctor will first determine the location of the tumour by using an ultrasound. The ultrasound will not only help the doctor localise the tumour but also determine its exact measurement.

A local anaesthetic is then used to numb the area, and a small incision is created in the skin. Being guided by the ultrasound, the doctor will insert a cryoprobe into the long axis of the fibroadenoma. The probe is guided into the centre of the tumour and activated. Due to the freezing temperature of the probe, the tumour forms into an ice-ball, after which it is thawed. The procedure is then repeated to ensure that the fibroadenoma is destroyed.

If two fibroadenomas are adjacent to each other, the cryoprobe can be used to destroy both tumours in a single procedure. The entire procedure usually takes less than 30 minutes to complete, but this depends on the number of fibroadenomas and their location. In many cases, the procedure causes only a minimal amount of discomfort, even during recovery.

After the procedure, the patient may feel as if the growth has gotten even larger. This feeling is common and should not be a source of concern. Moreover, because the cryoablation is minimally invasive, there should be little to no scarring. Also, there should not be any deformity of the breast even when the fibroadenoma has been removed because the surrounding tissue will grow to fill up the space where the tumour was located.

The tumour is expected to reduce in size after three months. The patient is then scheduled for follow-up visits wherein the doctor will measure the size of the tumour using ultrasound.

Possible Risks and Complications

The risks associated with an ultrasound-guided cryosurgical ablation of a fibroadenoma are few. These include bruising, swelling, and pain where the cryoprobe was inserted. There is also a risk of bleeding and infection.

Patients should keep in mind that cryoablation involves extremely cold temperatures. As such, there’s a risk of damage to the surrounding area. There is also a risk that the skin over the fibroadenoma may die, but this is an extremely rare occurrence.

References:

  • Premera Blue Cross “Cryosurgical Ablation of Miscellaneous Solid Tumors Other Than Liver, Prostate, or Dermatologic Tumors”: https://www.premera.com/medicalpolicies/7.01.526.pdf

  • Moda Health Medical Necessity Criteria “Cryoablation of Breast Fibroadenomas”: https://www.modahealth.com/pdfs/med_criteria/CryoablationofBreastFibroadenomas.pdf

  • L. Niu, B. Wu, K. Xu; “Cryosurgery for Breast Fibroadenomas” http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4115690/

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