The most recent study published in the British Journal of Surgery demonstrated that over 90 per cent of patients were happy with the conservative approach', supporting an earlier study from Oxford*. Our detailed study of the natural history of fibroadenoma has shown that few increase in size and that approximately one-third get smaller or disappear within 2 years of diagnosis'. This study also demonstrated that conservative management is safe, at least in younger patients.
I was surprised at the scant attention given to the use of ultrasonography as a diagnostic technique for fibroadenomas. As the authors point out, a combination of cytological diagnosis and clinical examination is not infallible, and a third diagnostic technique is necessary to try and limit the number of malignant lesions that are misdiagnosed. Ultrasonography is of value in follow-up. The regimen outlined previously' was that all patients should have a single follow-up scan at 6months to ensure that the lesion has not changed in size or that the characteristics of the lesion have not changed.
I note that there was no reference to support the statement 'excision has the attractions of minimal morbidity.. .'. A followup study of patients undergoing breast biopsy for lesions suhsequently shown to be benign demonstrated that breast biopsy is not a procedure with minimal morbidity and should only be performed when there is a clear indication'.