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Fibroadenoma - Large Biopsy 3-6 cm

Biopsy
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Breast lump biopsy.

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Fibroadenoma - Large Biopsy 3-6 cm

  • Why is it done?
    • To obtain a definitive tissue diagnosis of a large breast fibroadenoma (3-6 cm) that has been identified on imaging studies such as ultrasound or mammography
    • To confirm benign nature of the lesion and rule out malignancy, phyllodes tumor, or other breast pathology
    • To assess for complex features within the fibroadenoma that may require surgical intervention or closer monitoring
    • Typically performed when imaging characteristics are ambiguous or when the lesion is enlarging and requires pathological evaluation
    • Performed in women of reproductive age presenting with a palpable breast mass or incidentally discovered lesion on imaging
    • Large biopsy technique (3-6 cm core or excisional) is preferred over smaller biopsies due to lesion size and need for complete histological evaluation
  • Normal Range
    • Histopathological Result: Benign fibroadenoma
    • Positive Interpretation: Microscopic findings show characteristic fibroadenoma histology with well-circumscribed lesion composed of epithelial and stromal components, no evidence of malignancy
    • Negative Result (Abnormal): Any finding indicating malignancy, phyllodes tumor, complex features, or atypia requiring further intervention
    • Size Measurement: Fibroadenoma specimen typically measures 3-6 cm in greatest dimension, correlating with imaging findings
    • Units: Millimeters (mm) for microscopic measurements; centimeters (cm) for gross specimen dimensions
    • Normal findings equate to benign diagnosis allowing conservative management with clinical follow-up; abnormal findings may necessitate surgical excision or additional imaging
  • Interpretation
    • Benign Fibroadenoma (Expected Finding):
      • Well-defined, non-encapsulated or partially encapsulated lesion
      • Mixture of epithelial and stromal (fibroblastic) components
      • Absence of nuclear atypia or mitotic activity
      • Indicates benign disease with excellent prognosis
    • Complex Fibroadenoma:
      • Presence of cysts, sclerosing adenosis, papillomas, or hyperplasia within fibroadenoma
      • Still benign but may warrant closer follow-up or excision
    • Phyllodes Tumor:
      • Increased stromal cellularity, increased mitoses, stromal overgrowth
      • Classified as benign, borderline, or malignant based on histological features
      • Requires wider surgical margins or mastectomy depending on grade
    • Atypical Findings:
      • Nuclear atypia, increased mitotic figures, or other worrisome features
      • May suggest malignancy or high-risk lesion requiring immediate surgical consultation and possible excision
    • Factors Affecting Interpretation:
      • Adequacy of tissue sampling (large biopsy reduces sampling error)
      • Tissue fixation and processing quality
      • Pathologist expertise in breast pathology
      • Concordance with imaging findings
  • Associated Organs
    • Primary Organ System:
      • Breast tissue - specifically evaluating lesions in the mammary gland
      • Integumentary system as the breast is a modified sweat gland
    • Diseases/Conditions Associated with Abnormal Results:
      • Invasive ductal carcinoma
      • Invasive lobular carcinoma
      • Malignant phyllodes tumor
      • Atypical hyperplasia
      • Breast lymphoma
      • Sarcoma of breast tissue
    • Potential Complications Associated with Abnormal Results:
      • If malignancy diagnosed: metastatic disease, need for chemotherapy/radiation, possible mastectomy
      • If phyllodes tumor diagnosed: risk of recurrence, potential need for wider excision or mastectomy
      • If atypical hyperplasia identified: significantly increased lifetime breast cancer risk requiring surveillance
  • Follow-up Tests
    • If Benign Fibroadenoma Confirmed:
      • Clinical breast examination every 6-12 months for first 2 years
      • Mammography or ultrasound in 6 months to assess for interval change
      • Annual imaging thereafter if stable
    • If Complex Fibroadenoma:
      • Ultrasound or MRI in 3 months to assess features
      • Consider surgical excision if rapid growth or patient anxiety
      • More frequent imaging (every 3-6 months) compared to simple fibroadenoma
    • If Phyllodes Tumor Identified:
      • Immediate surgical oncology consultation
      • Wide surgical excision with adequate margins (1-2 cm) based on grade
      • MRI or CT imaging to assess for metastatic disease
      • Close follow-up imaging and clinical examination every 3-6 months for 2 years, then annually
    • If Malignancy Identified:
      • Urgent surgical oncology consultation and multidisciplinary tumor board review
      • Staging studies: CT chest/abdomen/pelvis, bone scan, or PET-CT
      • Immunohistochemistry (ER, PR, HER2) and genetic testing if appropriate
      • Surgical resection, chemotherapy, radiation, and/or hormonal therapy as determined by oncology team
    • If Atypical Features Present:
      • Surgical excision recommended
      • Risk assessment for breast cancer development
      • Enhanced surveillance mammography every 6-12 months
      • Consider risk reduction strategies (tamoxifen) in select cases
  • Fasting Required?
    • Answer: No
    • Fasting is not required for a breast fibroadenoma biopsy as this is a tissue sampling procedure, not a laboratory blood test
    • Medications:
      • Discontinue aspirin, NSAIDs, and anticoagulants (warfarin, DOACs) 3-5 days prior to procedure if possible to minimize bleeding risk
      • Consult with interventional radiologist or surgeon regarding specific anticoagulation management if patient is on warfarin or other anticoagulants
      • Continue all other routine medications unless otherwise instructed
    • Patient Preparation:
      • Wear comfortable, easily removable clothing with front-opening top
      • Avoid applying deodorant, lotions, or powders to breast area on day of procedure
      • Perform procedure during follicular phase of menstrual cycle if possible (less breast tenderness)
      • Arrange for transportation as sedation may be used and driving is not recommended immediately after procedure
      • Wear supportive bra on day of procedure; bring it with you if performing excisional biopsy
      • Bring photo ID and insurance information
      • Arrive 15 minutes early for check-in

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