Gonnah Ahmed R, Masoud Omar, AbdelWahab Mohamed, ElMosalamy Ahmed, Al-Naseem Abdulrahman
School of Medicine, University of Liverpool, Liverpool, UK.
Faculty of Life Sciences and Medicine, King's College London, London, UK.
Breast Care (Basel). 2023 Aug;18(4):279-288. doi: 10.1159/000524738. Epub 2022 May 2.
Fibroadenomas are solid, mobile, and non-tender benign breast lumps, with highest prevalence amongst young women aged between 15 and 35. Symptoms can include discomfort, and they can become problematic, particularly when they enlarge, resulting in many referrals for biopsies, with fibroadenomas accounting for 30-75% of the cases. Diagnosis is based on triple assessment that involves a clinical examination, ultrasound imaging, and mammography, as well as core needle biopsies. Current management includes observation for 6-12 months, with the indication of definitive surgery, in cases that are older than 35 years or with fibroadenoma persistence. Serious adverse effects of surgery might include nipple areolar distortion, scarring, and damage to the breast tissue, as well as the risks associated with surgery and anesthesia, making it a non-feasible option.
A literature search was performed on the databases Embase, MEDLINE/PubMed, Google Scholar, and Ovid for English language papers published between January 1, 2000, and March 17, 2021. A structured protocol was employed to devise a comprehensive search strategy with keywords and Boolean operators defined by the research question. The keywords used for the search were "HIFU", "High Intensity Focused Ultrasound," "Fibroadenoma," "Breast," "Lesion." This review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Recently, a thermal ablative technique, high intensity focused ultrasound (HIFU), was found to be a safe, noninvasive, and technically successful alternative, having displayed promising outcomes in reducing the volume of fibroadenomas, pain experienced by patients, and the length of hospitalization. Quality of life improvement was also evidenced, exhibited by the disappearance of symptoms, and enhanced physical activity post-intervention, in addition to patients' satisfaction with the cosmetic results and future recommendation of the procedure to other patients.
Overall, HIFU is a well-tolerated treatment associated, with low risk of complications, that can potentially include erythema, skin discoloration, and bruising with the majority of these self-resolving shortly after the procedure.
纤维腺瘤是实性、可移动且无压痛的乳腺良性肿块，在15至35岁的年轻女性中发病率最高。症状可能包括不适，而且它们可能会引发问题，尤其是当它们增大时，这导致许多患者转诊进行活检，纤维腺瘤占活检病例的30 - 75%。诊断基于三联评估，包括临床检查、超声成像、乳腺X线摄影以及粗针活检。目前的治疗方法包括观察6 - 12个月，对于年龄大于35岁或纤维腺瘤持续存在的病例，需进行确定性手术。手术的严重不良反应可能包括乳头乳晕变形、瘢痕形成以及乳腺组织损伤，还有与手术和麻醉相关的风险，这使得手术成为一种不可行的选择。
在Embase、MEDLINE/PubMed、谷歌学术和Ovid数据库中进行文献检索，查找2000年1月1日至2021年3月17日期间发表的英文论文。采用结构化方案，根据研究问题定义关键词和布尔运算符，设计全面的检索策略。检索使用的关键词为“高强度聚焦超声（HIFU）”“高强度聚焦超声”“纤维腺瘤”“乳腺”“病变”。本综述按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行。
最近，一种热消融技术——高强度聚焦超声（HIFU），被发现是一种安全、无创且技术上成功的替代方法，在减少纤维腺瘤体积、患者疼痛以及住院时间方面显示出了有前景的结果。生活质量的改善也得到了证实，表现为症状消失、干预后身体活动增强，此外患者对美容效果满意并愿意向其他患者推荐该治疗方法。
总体而言，HIFU是一种耐受性良好的治疗方法，并发症风险低，可能包括红斑、皮肤变色和瘀伤，大多数在术后不久会自行消退。
