الفهرس 
Gross anatomy of the breastOnly 14 pages are availabe for public view
 |  | from | 115 |  |  |
| | | from | 115 | | |
Abstract
Our study shows that ultrasound-guided, vacuum-assisted excision can play an efficient role in the diagnosis of benign breast lesions and is a safe and successful alternative in treatment of fibroadenomas.
Although the breast fibroadenoma is a common benign breast tumor, the treatment and follow-up of these lesions is still debatable. We suggest that UGVAB, which has a well-documented role in the diagnosis of breast lesions, may provide an option for the definitive treatment of breast fibroadenomas.
FIBROADENOMA is the most common breast tumor in adolescent girls and women younger than 25 years. Although the peak incidence is between the second and third decades of life, it is not uncommon in postmenopausal women, with an increased incidence after hormone replacement therapy.( Rosen PP 2006 ) Overall, it occurs in approximately 10% of women and accounts for about 50% of breast biopsies performed.( Greenberg 1998 ).
Fibroadenomas are benign tumors that are sharply demarcated from the surrounding tissue; some authors even consider them to be an aberration of normal development rather than a true neoplasm.( REWebster 2010). They consist of combined proliferation of epithelial and connective tissue elements, and there is good histologic evidence that these tumors develop from a lobular origin. (LEMansel 2005). This may explain the high incidence of fibroadenomas in young women at the time of maximal lobular development and why the very rare cases of cancer that arise in fibroadenomas are of lobular origin (lobular carcinoma in situ).
The usual clinical presentation is a palpable lesion detected incidentally during a medical or self-examination. It is typically a solitary, nontender, smooth, freely mobile mass of 1 to 3 cm. Only 20% of cases are multiple or greater than 4 cm. Most fibroadenomas are static or cease growth at approximately 2 to 3 cm, about 15% of tumors regress spontaneously, and only 5% to 10% progress. Cancer arising in the fibroadenoma is extremely rare.( DPTaylor 2005).
The characteristic clinical presentation can provide an accurate diagnosis based on physical examination alone in only 50% to 67% of fibroadenomas; thus, diagnosis should be based on supporting data, such as findings from imaging and tissue study. Ultrasound examination is the method of choice in the evaluation and follow-up of fibroadenomas in younger patients. The characteristic sonographic appearance of a fibroadenoma is an ovoid smooth solid mass, narrower in its anteroposterior diameter than its transverse diameter, with even, low-level internal echoes. (J Surg Oncol. 2013) This appearance is not characteristic of all fibroadenomas, however. Mammographically, fibroadenomas are usually well-circumscribed lesions, but 25% may have features suggestive of malignancy (eg, irregular outline). Although the role of mammography in the diagnosis of fibroadenoma is limited in young women, it can be helpful in older women, especially in those with nonpalpable lesions. During the last decade, percutaneous tissue diagnosis has been a major tool in the evaluation of breast masses. (AJMcWey PJ et al 2012).
Vacuum assisted image-guided breast biopsies are rapid, minimally invasive procedures that make surgery unnecessary for a large majority of patients whose lesions will prove to be benign. The image guided biopsies are performed under local anesthetic with no need for conscious sedation using a small incision that requires no stitches to close.
The procedures do not deform the breast and cause minimal to no scarring on subsequent mammograms. Complications, such as hematoma and infection are rare, occurring in less than 1 per 1000.
Vacuum assisted Ultrasound-guided biopsy allows real-time imaging, can be performed without breast compression, and is the preferred method if the lesion is detectable with ultrasound .