From Cut and Run to Watch and Wait: A Changing Paradigm for the Management of Breast Fibromatosis

Breast fibromatosis (BF) is a rare disease of monoclonal fibroblast proliferation, accounting for only 0.2% of all breast tumors. It behaves unpredictably, in some cases becoming locally aggressive and therefore can be a source of significant morbidity. Fibromatosis cannot reliably be distinguished with imaging from more aggressive malignancies such as spindle cell-type metaplastic carcinoma, and therefore, core needle biopsies are integral to definitive diagnosis. Appropriate management of BF is an evolving topic. Historically, BF was treated with extensive surgical resection. However, newer management guidelines recommend initiating a 1- to 2-year period of active surveillance before resorting to systemic medical therapy, surgical resection, and/or radiotherapy. Radiologists play an integral role in arriving at diagnosis, determining concordance, and triaging affected patients for treatment. This article aims to review the current literature on the diagnosis and management of fibromatosis of the breast, with a focus on imaging features and the latest therapeutic options.