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Young women with a breast lump that appears benign on examination and ultrasound need not undergo biopsy, UK radiologists have proposed. "Young women with a breast lump that appears benign on examination and ultrasound need not undergo histological confirmation of the diagnosis, UK radiologists have proposed [1].

Current practice involves 'triple assessment' with clinical examination, imaging and histological diagnosis. However, researchers suggest that in some cases 'double assessment' - examination and imaging only - "may be sufficient."

They assessed histological findings in 357 women under the age of 25 with an ultrasound diagnosis of fibroadenoma. This diagnosis was confirmed in 281 patients - 78.8 per cent. A further 75 patients, or 21.5 per cent, were shown to have either another benign pathology or benign breast change.

Just one invasive carcinoma was reported. However, retrospective analysis revealed features of malignancy in the original ultrasound scan.

The researchers said: "We propose that only lesions that are not definitely radiologically benign on ultrasound should be biopsied. Similarly, if there is clinical concern about the nature of the lump then it should be biopsied regardless of the imaging findings."

They added: "Women under the age of 25 years who have a benign lump on ultrasound should be reassured and advised that if they notice any increase in size or other change in the mass then they should seek prompt referral for further assessment."

However Dr Barbara Dall, a consultant radiologist from Leeds, UK, with an interest in breast radiology, cautioned: "An unfortunate truth is that breast cancers in young women, as well as being unexpected, are often surprisingly benign looking" [2].

She noted in an accompanying commentary that "a policy of clinical and ultrasound assessment only puts a much more onus on the rigorous performance and interpretation of the ultrasound examination," and suggested "a very cautious approach".


[1] Ultrasound diagnosis of fibroadenoma - is biopsy always necessary?
Clin Radiol;63:511-515

[2] Commentary: Ultrasound diagnosis of fibroadenoma - is biopsy always necessary?
Clin Radiol;63:516-517"