Diagnosis and Management of Breast Fibroadenomas

!2th July 2026, NIA Diagnostic Imaging

Is that a fibroadenoma?

Breast fibroadenomas are common benign breast tumours that primarily occur in women of reproductive age (1). They are composed of both glandular and connective tissue tissue, and typically present as a well-defined, firm and mobile lump (4). Though fibroadenomas are not cancerous, they are clinically significant due to the potential to mimic the clinical and imaging features of breast cancer. Therefore, it is essential to establish the correct diagnosis to guide appropriate management and ensure timely care.

What causes breast fibroadenomas?

The cause of fibroadenomas is not fully understood, however, it appears that fibroadenomas are hormone-related with increased growth of glandular and connective tissue. For this reason, fibroadenomas may proliferate during pregnancy or other periods of hormonal change, and become smaller after menopause (1).

What are the signs and symptoms?

Many fibroadenomas may be discovered incidentally during routine breast imaging. Common signs and symptoms include: (1, 3)

Painless, firm breast lump
May be mobile underneath the skin
Changes in appearance or contour of breast

What is the first diagnostic tool?

Diagnosis of fibroadenomas is based on a combination of clinical examination, breast imaging and histopathological confirmation, where necessary (3). Breast ultrasound is the preferred first-line imaging tool for young women with dense breast tissue due to its widespread availability, does not use ionising radiation and real time assessment (4). Mammography may be used as adjunct, particularly in older women or when additional imaging is indicated.

Ultrasound helps clinicians (3):

Assessment of size, location and internal characteristics of the lesion
Monitor changes with serial ultrasound examinations
Guide biopsy procedures when tissue sampling is required
On ultrasound, fibroadenomas typically appear as (1, 3):
Well-defined, oval or round masses
Uniformly hypoechoic
Smooth, circumscribed margins

What are the clinical management and treatment options?

Clinical management and treatment planning of fibroadenomas are individualised, and depend on the size, patient symptoms, age, imaging findings and personal preference.

Observation: Most fibroadenomas do not require surgical treatment and can be managed conservatively with regular clinical assessment and follow up imaging to monitor for changes.
Biopsy: For uncertain imaging findings, increasing size or atypical features, a biopsy (such as fine-needle aspiration or core needle biopsy) may be performed for definitive diagnosis.
Surgical and minimally invasive treatment: For fibroadenomas that require surgical management, various options include excisional biopsy, lumpectomy and cryoablation in selected patients.

Conclusion

At NIA Diagnostic Imaging, high-resolution breast ultrasound using GE LOGIQ™ E10 ultrasound systems provides detailed assessment of breast tissue, helping identify and characterise fibroadenomas while supporting accurate diagnosis and appropriate patient management.

References:

Ajmal, M., Khan, M., & Van Fossen, K. Breast fibroadenoma. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK535345/
Nnadi, C. (2025). Fibroadenoma [Image]. Med Bullets. https://step2.medbullets.com/gynecology/120421/fibroadenoma
Pandit, P., Murkey, S. P., Agarwal, A., Jaiswal, A., & Agrawal, S. (2023). Understanding fibroadenoma of the breast: A comprehensive review of pre-operative and post operative clinicopathological correlations. Cureus, 15(12). https://doi.org/10.7759/cureus.51329
Ramala, S. R., Jr, Chandak, S., Chandak, M. S., & Annareddy, S. (2023). A comprehensive review of breast fibroadenoma: Correlating clinical and pathological findings. Cureus, 15(12). https://doi.org/10.7759/cureus.4994

PFO Closure

Furlan AJ, Reisman M, Massaro J, et al. Closure or medical therapy for cryptogenic stroke with patent foramen ovale. N Engl J Med 2012; 366: 991–

A multicenter, randomized, open-label trial of closure with a percutaneous device, as compared with medical therapy alone, in patients between 18 and 60 years of age who presented with a cryptogenic stroke or transient ischemic attack (TIA) and had a patent foramen ovale. The primary end point was a composite of stroke or transient ischemic attack during 2 years of follow-up, death from any cause during the first 30 days, or death from neurologic causes between 31 days and 2 years.

Results:

Primary end point was 5.5% in the closure group as compared with 6.8% in the medical-therapy group (adjusted hazard ratio, 0.78; 95% confidence interval, 0.45 to 1.35; P = 0.37)

Conclusion:

“In patients with cryptogenic stroke or TIA who had a patent foramen ovale, closure

with a device did not offer a greater benefit than medical therapy alone for the

prevention of recurrent stroke or TIA”

2 Saver JL, Carroll JD, Thaler DE, et al. Long-term outcomes of patent foramen ovale closure or medical therapy after stroke. N Engl J Med 2017; 377: 1022–

A multicenter, randomised, open-label trial ,randomly assigned patients 18 to 60 years of age who had a patent foramen ovale (PFO) and had had a cryptogenic ischemic stroke to undergo closure of the PFO (PFO closure group) or to receive medical therapy alone (aspirin, warfarin, clopidogrel, or aspirin combined with extended-release dipyridamole; medical-therapy group). The primary efficacy end point was a composite of recurrent nonfatal ischemic stroke, fatal ischemic stroke, or early death after randomisation.

Results:

Recurrent ischemic stroke occurred in 18 patients in the PFO closure group and in 28 patients in the medical-therapy group, resulting in rates of 0.58 events per 100 patient-years and 1.07 events per 100 patient years, respectively (hazard ratio 0.55; 0.31 – 0.999; P = 0.046)

Conclusion:

“Among adults who had had a cryptogenic ischemic stroke, closure of a PFO was associated with a lower rate of recurrent ischemic strokes than medical therapy alone during extended follow-up.”

Meier B, Kalesan B, Mattle HP, et al. Percutaneous closure of patent foramen ovale in cryptogenic embolism. N Engl J Med 2013; 368: 1083–

A prospective, multicenter, randomised, event-driven trial, randomly assigned patients to medical therapy alone (anti-platelet or warfarin therapy) or closure of the patent foramen ovale.

Results:

9 patients in the closure group and 16 in the medical-therapy group had a recurrence of stroke (hazard ratio with closure, 0.49; 0.22 – 1.11; P = 0.08). The primary analysis of the intentionto- treat cohort showed a nominal 51% hazard rate reduction with closure, but the reduction did not reach significance.

Conclusions:

” …there was no significant benefit associated with closure of a patent foramen ovale in adults who had had a cryptogenic ischaemic stroke.”

Sondergaard L, Kasner SE, Rhodes JF, et al. Patent foramen ovale closure or antiplatelet therapy for cryptogenic stroke. N Engl J Med 2017; 377: 1033–

Multinational trial involving patients with a PFO who had had a cryptogenic stroke, randomly assigned patients to undergo PFO closure plus antiplatelet therapy or to receive antiplatelet therapy alone.

Results:

During a median follow-up of 3.2 years, clinical ischemic stroke occurred in 6 of 441 patients (1.4%) in the PFO closure group and in 12 of 223 patients (5.4%) in the antiplatelet-only group (hazard ratio, 0.23; 0.09 to 0.62; P=0.002).

Conclusions:

“Among patients with a PFO who had had a cryptogenic stroke, the risk of subsequent ischemic stroke was lower among those assigned to PFO closure combined with antiplatelet therapy than among those assigned to antiplatelet therapy alone; however, PFO closure was associated with higher rates of device complications and atrial fibrillation.”

Mas JL, Derumeaux G, Guillon B, et al. Patent foramen ovale closure or anticoagulation vs. antiplatelets after stroke. N Engl J Med 2017; 377: 1011–

In a multicenter, randomised, open-label trial patients 16-60 years of age who had had a recent stroke attributed to PFO, to transcatheter PFO closure plus long-term antiplatelet therapy, antiplatelet therapy alone or oral anticoagulation.

Results:

No stroke occurred among patients in the PFO closure group, whereas stroke occurred in 14 of the 235 patients in the antiplatelet- only group (hazard ratio, 0.03; 0 to 0.26; P<0.001). Large number of patients discontinued anti-coagulation in the anti-coagulant group and statistical significance was not analysed because the study was not adequately powered to compare outcomes.

Conclusion:

“Among patients who had had a recent cryptogenic stroke attributed to PFO with an associated atrial septal aneurysm or large interatrial shunt, the rate of stroke recurrence was lower among those assigned to PFO closure combined with antiplatelet therapy than among those assigned to antiplatelet therapy alone. PFO closure was associated with an increased risk of atrial fibrillation.”

Lee PH, Song J-K, Kim JS, et al. Cryptogenic stroke and high-risk patent foramen ovale: the DEFENSE-PFO Trial. J Am Coll Cardiol 2018; 71: 2335–

Patients with cryptogenic stroke and high-risk PFO were divided between a transcatheter PFO closure and a medication-only group.

Results:

No events occurred in the PFO closure group. 12.9% of patients in the medication group had an event (p= 0.023).

Conclusion:

“PFO closure in patients with high-risk PFO characteristics resulted in a lower rate of the primary endpoint as well as stroke recurrence”