Non-biopsy of fibroadenomas in the UK and Ireland: a British Society of Breast Radiology survey of national practice

Abstract

Aim

Fibroadenomas are the commonest solid breast mass in young women. Current Royal College of Radiologists' (RCR) guidance, produced by the British Society of Breast Radiology (BSBR), recommends that needle biopsy can be safely avoided in women aged under 25, provided strict imaging criteria are met, but may be increased to under 30 years with robust audit. The aim was to assess national practice against current guidance prior to its planned update.

Materials & Methods

A BSBR survey of practice investigated non-biopsy of fibroadenomas in breast units across the UK and Ireland.

Results

Data were analysed from 55 breast units, with a representative geographic spread across all nations. 30/55 units (55%) currently use the ‘under 25 years’ biopsy age range; 20/55 (36 %) use ‘under 30 years’, and 5/55 (9 %) use another age range. All units using ‘under 30 years’ are happy with the cut-off; most have audited their practice, all confirming it as safe. 29 of 30 units still using ‘under 25 years’ would be prepared to move to ‘under 30’ pending definitive guidance or further evidence. Only 3 units use elastography alongside greyscale ultrasound for assessing fibroadenomas.

Conclusion

Findings reflect an underlying change in practice and demonstrate support for RCR guidance to extend non-biopsy of typical fibroadenomas to women under 30 years, provided strict imaging and clinical criteria are followed. Although elastography may support decision-making, it is currently not in widespread use. Units should ensure safe practice through a robust audit. Further published evidence to support safe practice post-implementation is also encouraged.