Cryotherapy for breast B3 fibroepithelial lesion: A first reported case and literature review

Background and purpose: Cryotherapy has been described for the treatment of fibroadenomas and selected early breast cancers (1). However, the use of cryotherapy for B3 fibroepithelial lesions (FELs), diagnosed on percutaneous needle biopsy, has not been described. These FELs usually warrant an excision since there is a risk of upgrade to phyllodes tumour (2). We report the outcome of a patient with breast B3 FEL. We also conducted a literature review and this is the first such reported case to the best of our knowledge. Methods: The patient was recruited as part of a prospective trial (ClinicalTrials.gov Identifier: NCT04571307) on B3 FELs diagnosed on percutaneous biopsy. Patients with tumour size >3cm were excluded. Cryotherapy was performed under local anaesthesia and the patients underwent post-treatment surveillance for recurrence. Pain score, return to work and cosmetic outcomes were recorded. Results: A 23-year-old lady underwent cryotherapy for a 17mm right breast mass (Figure 1) with no complications. Pain score was minimal (0- 1) immediately after the procedure and at 2 weeks' review. Return to work was possible a day after cryotherapy. At 4 months' follow-up, the patient reported excellent cosmetic outcome with minimal scarring. Ultrasound showed the mass had slightly increased in size (20mm). It also developed heterogeneous hyperechoic internal echoes and ill-defined margins (Figure 2). Conclusion: Short term follow-up of our first case of cryotherapy for a B3 FEL showed no significant complications so far. Early results showed that it may be a feasible method to treat such lesions without affecting cosmesis. We await further validation with more patients and longer-term follow-up. References 1. Simmons RM, Ballman KV, Cox C et al; ACOSOG investigators. A Phase II Trial Exploring the Success of Cryoablation Therapy in the Treatment of Invasive Breast Carcinoma: Results from ACOSOG (Alliance) Z1072. Ann Surg Oncol. 2016;23:2438- 45 2. Ooi LY, Lim GH, Gudi MA. Effect of pregnancy and lactation on a benign phyllodes tumour. BMJ Case Rep. 2022;15:e247340. Legends