4.1: Nonbiopsy of presumed fibroadenomas in patients <30 years: is it safe? A single unit experience and review of European practice

Introduction

Previous research in this centre enabled the introduction of a local protocol of nonbiopsy and discharge of women <30 years old with presumed fibroadenomas (FAs). Four years on, we have audited protocol accuracy, effect on biopsy workload, safety and its potential for influencing UK and European practice.

Methods

Women aged <30 attending the breast unit between 1 February 2009 and 31 January 2013 were retrospectively identified. Clinical and imaging results were scored following national guidelines locally adapted to incorporate a nonbiopsy protocol such that presumed FAs scored E2/U2 meeting specific protocol criteria were discharged without core biopsy. In addition, a survey assessing European practice was completed by 31 centres.

Results

A total of 1,571 women age <30 were referred to the breast unit. Seven cancers were diagnosed, all aged 25 to 29. In total, 266 presumed FAs E2/U2, meeting nonbiopsy criteria were discharged without biopsy, 84 were aged 25 to 29. Fourteen re-attended with increase in size, none biopsied but five excised due to patient choice. Sixty-six E2/U2, probable FAs were biopsied due to noncompliance with the protocol. Of these, 54 were FAs, seven phyllodes tumours, and one cancer. The protocol resulted in a 78% reduction in biopsy workload in women aged ≥20 and a 72% reduction in women aged 25 to 29. No cancers developed in discharged patients, mean follow up 2.4 years. European survey results demonstrate 29% of respondents routinely sample FAs in women age ≥20, 55% in women age ≥25. Seventy-nine per cent of non-UK respondents follow-up FAs regardless of patient age.

Conclusion

With rigorous adherence, our nonbiopsy protocol for presumed FAs in women age <30 appears safe and reduces biopsy/follow-up workload.