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Choi JS, Ko EY, Kim MJ, Ko ES, Han BK. Combined use of shear-wave elastography and Doppler ultrasonography in equivocal fibroepithelial lesions of the breast diagnosed by core needle biopsy. Ultrasonography 2023; 42:31-40. [PMID: 36353790 PMCID: PMC9816696 DOI: 10.14366/usg.22008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/17/2022] [Indexed: 11/11/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the diagnostic value of shear-wave elastography (SWE) combined with Doppler ultrasonography (US) in selecting equivocal breast fibroepithelial lesions (FELs) for follow-up without further excision. METHODS A retrospective analysis was conducted of 88 patients with equivocal breast FELs (FELs with the possibility of both fibroadenoma [FA] and phyllodes tumor [PT]) diagnosed by core needle biopsy (CNB). For post-CNB treatment, surgical or vacuum-assisted excision was performed on 88 equivocal FELs, of which 56 were diagnosed as FAs and 32 as PTs on histopathology. Mean elasticity (Emean) and vascularity were determined using SWE and Doppler US. The diagnostic performances of B-mode US, SWE, and Doppler US were calculated to differentiate FAs and PTs in the excised equivocal FELs. RESULTS In the excised equivocal FELs diagnosed by CNB, FAs showed significantly lower median Emean values (36.4 vs. 66.7 kPa, P=0.005) and more frequent low vascularity (0-1 vessel flow signal) (P<0.001) than PTs. For the differentiation of FAs and PTs, the combination of Emean of >60.9 kPa and high vascularity (≥2 vessel flows) showed a sensitivity and negative predictive value of 100%, as well as better performance in other diagnostic values than B-mode US alone (Breast Imaging Reporting and Data System ≥4A) (all P<0.05). CONCLUSION Equivocal breast FELs showing both low elasticity and low vascularity were not upgraded to PTs upon further excision. Therefore, the combination of SWE and color Doppler US mode might help select patients with equivocal FELs for whom further excision is unnecessary.
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Affiliation(s)
- Ji Soo Choi
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea,Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Eun Young Ko
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea,Correspondence to: Eun Young Ko, MD, PhD, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Tel. +82-2-3410-2519 Fax. +82-2-3410-2509 E-mail:
| | - Min-Ji Kim
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Eun Sook Ko
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Boo-Kyung Han
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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2
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Ni Y, Tse GM. Spindle Cell Lesions of the Breast: A Diagnostic Algorithm. Arch Pathol Lab Med 2023; 147:30-37. [PMID: 35976671 DOI: 10.5858/arpa.2022-0048-ra] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 12/31/2022]
Abstract
CONTEXT.— Spindle cell lesions of the breast represent a broad spectrum of entities, ranging from nonneoplastic reactive conditions to high-grade malignant tumors. The wide range makes breast spindle cell lesions a diagnostic pitfall. OBJECTIVE.— To review the classification of spindle cell lesions of the breast, including clinical features, morphologic characteristics, and the role of immunohistochemistry as well as molecular tools in assisting the differential diagnosis. A diagnostic algorithm will be proposed. DATA SOURCES.— Literature and personal experience are the sources for this study. CONCLUSIONS.— Spindle cell lesions of the breast can be classified as biphasic or monophasic, with the former including both spindle cell and epithelial components, and the latter including only spindle cell elements. Each category is further subclassified as low or high grade. In the biphasic low-grade group, fibroadenoma and benign phyllodes tumor are the most common lesions. Other uncommon lesions include hamartoma, adenomyoepithelioma, and pseudoangiomatous stromal hyperplasia. In the biphasic high-grade group, borderline/malignant phyllodes tumor and biphasic metaplastic carcinoma are the main lesions to consider. In the monophasic low-grade group, reactive spindle cell nodule, nodular fasciitis, myofibroblastoma, fibromatosis, and fibromatosis-like metaplastic carcinoma have to be considered. In the monophasic high-grade group, the possible lesions are monophasic spindle cell metaplastic carcinoma, primary breast sarcoma, and metastases. Awareness of the clinical history and careful evaluation of any epithelial differentiation (with a large immunohistochemical panel) are crucial in the distinction.
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Affiliation(s)
- Yunbi Ni
- From the Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Gary M Tse
- From the Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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3
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Tan BY, Fox SB, Lakhani SR, Tan PH. Survey of recurrent diagnostic challenges in breast phyllodes tumours. Histopathology 2023; 82:95-105. [PMID: 36468287 DOI: 10.1111/his.14730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/15/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND Breast phyllodes tumours (PTs) are graded as benign, borderline, or malignant by analysis of multiple histological features. PT grading is often inconsistent, likely due to variation in the weighting of grading criteria by pathologists. DESIGN The hierarchy of use of diagnostic criteria was identified using a 20-question survey. RESULTS In all, 213 pathologists from 29 countries responded. 54% reported 10-50 PT cases per year. Criteria considered key to PT diagnosis were: increased stromal cellularity (84.3%), stromal overgrowth (76.6%), increased stromal mitoses (67.8%), stromal atypia (61.5%), stromal fronding (59.0%), periductal stromal condensation (58.0%), irregular tumour borders (46.3%), and/or lesional heterogeneity (33.7%). The importance of grading parameters were: mitotic activity (55.5%), stromal overgrowth (54.0%), stromal atypia (51.9%), increased stromal cellularity (41.7%), and nature of the tumour border (38.9%). 49% would diagnose malignant PT without a full array of adverse features. 89% used the term "cellular fibroepithelial lesion (FEL)" for difficult cases; 45% would diagnose an FEL with stromal fronding (but lacking other PT features) as fibroadenoma (FA), 35% FEL, and 17% PT. 59% deemed clinico-radiological findings diagnostically significant; 68% considered age (≥40 years) important in determining if an FEL was a FA or PT. In FELs from young patients, increased stromal cellularity (83%), fronding (52%), and mitoses (41%) were more common. 34% regarded differentiating cellular FA from PT as a specific challenge; 54% had issues assigning a borderline PT grade. CONCLUSION Criteria for grading PT lie on a spectrum, leading to interpretive variability. The survey highlights the criteria most used by pathologists, which do not completely align with WHO recommendations.
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Affiliation(s)
| | - Stephen B Fox
- Peter MacCallum Cancer Centre and University of Melbourne, Australia
| | - Sunil R Lakhani
- The University of Queensland and Pathology Queensland, Australia
| | - Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Singapore
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Phyllodes Tumors of the Breast: A Rare Lesion with Still-Evolving Prognostic Features and Clinical Management. CURRENT RADIOLOGY REPORTS 2022. [DOI: 10.1007/s40134-022-00403-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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5
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Tumor Location in the Head/Uncinate Process and Presence of Fibrosis Impair the Adequacy of Endoscopic Ultrasound-Guided Tissue Acquisition of Solid Pancreatic Tumors. Cancers (Basel) 2022; 14:cancers14143544. [PMID: 35884606 PMCID: PMC9320263 DOI: 10.3390/cancers14143544] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/20/2022] [Accepted: 07/20/2022] [Indexed: 02/05/2023] Open
Abstract
Simple Summary Endoscopic ultrasound-guided tissue acquisition is the most accurate method to diagnose pancreatic tumors; nevertheless, this technique does not always bring adequate diagnostic accuracy. This study aimed to identify which factors can impair its adequacy. Pancreatic cytological and histological aspirates were retrospectively assessed according to two scores for grading the adequacy and the fibrosis of the specimens. The performance of the biopsies was lower when the tumor was located in the head/uncinate process of the pancreas, probably due to the higher fibrosis that we found in these sites. The specimens were less adequate also when <3 needle passes were performed and when the cell block was not done. We demonstrated the benefit to assess the presence of fibrosis in the specimens because it increased the risk of false negative results. Abstract Endoscopic ultrasound-guided tissue acquisition (EUS-TA) of solid pancreatic tumors shows optimal specificity despite fair sensitivity, with an overall suboptimal diagnostic yield. We aim to quantify the adequacy and accuracy of EUS-TA and assess predictive factors for success, focusing on the presence and degree of specimen fibrosis. All consecutive EUS-TA procedures were retrieved, and the specimens were graded for sample adequacy and fibrosis. The results were evaluated according to patients’ and tumor characteristics and the EUS-TA technique. In total, 407 patients (59% male, 70 [63–77] year old) were included; sample adequacy and diagnostic accuracy were 90.2% and 94.7%, respectively. Fibrosis was significantly more represented in tumors located in the head/uncinate process (p = 0.001). Tumor location in the head/uncinate (OR 0.37 [0.14–0.99]), number of needle passes ≥ 3 (OR 4.53 [2.22–9.28]), and the use of cell block (OR 8.82 [3.23–23.8]) were independently related to adequacy. Severe fibrosis was independently related to false negative results (OR 8.37 [2.33–30.0]). Pancreatic tumors located in the head/uncinate process showed higher fibrosis, resulting in EUS-TA with lower sample adequacy and diagnostic accuracy. We maintain that three or more needle passes and cell block should be done to increase the diagnostic yield.
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Computer-Aided Detection of Quantitative Signatures for Breast Fibroepithelial Tumors Using Label-Free Multi-Photon Imaging. MOLECULES (BASEL, SWITZERLAND) 2022; 27:molecules27103340. [PMID: 35630817 PMCID: PMC9144626 DOI: 10.3390/molecules27103340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/17/2022]
Abstract
Fibroadenomas (FAs) and phyllodes tumors (PTs) are major benign breast tumors, pathologically classified as fibroepithelial tumors. Although the clinical management of PTs differs from FAs, distinction by core needle biopsy diagnoses is still challenging. Here, a combined technique of label-free imaging with multi-photon microscopy and artificial intelligence was applied to detect quantitative signatures that differentiate fibroepithelial lesions. Multi-photon excited autofluorescence and second harmonic generation (SHG) signals were detected in tissue sections. A pixel-wise semantic segmentation method using a deep learning framework was used to separate epithelial and stromal regions automatically. The epithelial to stromal area ratio and the collagen SHG signal strength were investigated for their ability to distinguish fibroepithelial lesions. An image segmentation analysis with a pixel-wise semantic segmentation framework using a deep convolutional neural network showed the accurate separation of epithelial and stromal regions. A further investigation, to determine if scoring the epithelial to stromal area ratio and the SHG signal strength within the stromal area could be a marker for differentiating fibroepithelial tumors, showed accurate classification. Therefore, molecular and morphological changes, detected through the assistance of computational and label-free multi-photon imaging techniques, enable us to propose quantitative signatures for epithelial and stromal alterations in breast tissues.
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7
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Seow DY, Tay TK, Tan PH. FIBROEPITHELIAL LESIONS OF THE BREAST: A REVIEW OF RECURRING DIAGNOSTIC ISSUES. Semin Diagn Pathol 2022; 39:333-343. [DOI: 10.1053/j.semdp.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/01/2022] [Accepted: 04/11/2022] [Indexed: 11/11/2022]
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8
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Cheng CL, Md Nasir ND, Ng GJZ, Chua KWJ, Li Y, Rodrigues J, Thike AA, Heng SY, Koh VCY, Lim JX, Hiew VJN, Shi R, Tan BY, Tay TKY, Ravi S, Ng KH, Oh KSL, Tan PH. Artificial intelligence modelling in differentiating core biopsies of fibroadenoma from phyllodes tumor. J Transl Med 2022; 102:245-252. [PMID: 34819630 DOI: 10.1038/s41374-021-00689-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 10/17/2021] [Accepted: 10/17/2021] [Indexed: 02/06/2023] Open
Abstract
Breast fibroepithelial lesions (FEL) are biphasic tumors which consist of benign fibroadenomas (FAs) and the rarer phyllodes tumors (PTs). FAs and PTs have overlapping features, but have different clinical management, which makes correct core biopsy diagnosis important. This study used whole-slide images (WSIs) of 187 FA and 100 PT core biopsies, to investigate the potential role of artificial intelligence (AI) in FEL diagnosis. A total of 9228 FA patches and 6443 PT patches was generated from WSIs of the training subset, with each patch being 224 × 224 pixel in size. Our model employed a two-stage architecture comprising a convolutional neural network (CNN) component for feature extraction from the patches, and a recurrent neural network (RNN) component for whole-slide classification using activation values from the global average pooling layer in the CNN model. It achieved an overall slide-level accuracy of 87.5%, with accuracies of 80% and 95% for FA and PT slides respectively. This affirms the potential role of AI in diagnostic discrimination between FA and PT on core biopsies which may be further refined for use in routine practice.
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Affiliation(s)
- Chee Leong Cheng
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Nur Diyana Md Nasir
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | | | | | - Yier Li
- AI Singapore, Singapore, Singapore
| | | | - Aye Aye Thike
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Seow Ye Heng
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Valerie Cui Yun Koh
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | | | - Venice Jing Ning Hiew
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Ruoyu Shi
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | | | | | | | | | | | - Puay Hoon Tan
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore. .,Division of Pathology, Singapore General Hospital, Singapore, Singapore.
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9
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Lynda A, Amal K, Salah EB. Performance of Elastography, Color Doppler and B Mode Ultrasound to Differentiate Fibroadenomas from Phyllodes Tumor. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2022. [DOI: 10.37015/audt.2022.220003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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10
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Lee A, James J, Whisker L, Rakha EA, Ellis IO. Which lesions with a radiological or core biopsy diagnosis of fibroadenoma should be excised? Ann R Coll Surg Engl 2021; 104:361-366. [PMID: 34939848 DOI: 10.1308/rcsann.2021.0208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION A recent Association of Breast Surgery summary statement on fibroadenoma management recommends excision only for cellular fibroepithelial lesions and rapidly growing lesions with a core biopsy diagnosis of fibroadenoma; persistent pain is a relative indication for excision. METHODS This retrospective study looked at the impact this approach would have on the diagnosis of phyllodes tumours. RESULTS From 2014 to 2018, there were 1,058 core biopsy diagnoses of fibroadenoma; 112 lesions were excised, of which 98 were fibroadenomas, 4 were hamartomas and 10 were phyllodes tumours. In this group, an excision diagnosis of phyllodes tumour was associated with size more than 40 mm, age more than 40 years and radiological suspicion of phyllodes tumour or carcinoma. One hundred and sixty-six excised fibroepithelial lesions with no previous core biopsy included eight phyllodes tumours; in this group, rapid growth was associated with phyllodes tumour diagnosis. Twelve of the 26 fibroepithelial lesions classified as B3 (cellular fibroepithelial lesion or phyllodes tumour) were diagnosed as phyllodes tumours on excision. Using a combination of radiological, clinical and pathological features it was possible to create an excision policy that would recommend excision of 22 of the 31 phyllodes tumours in this period. Eight of the nine 'missed' phyllodes tumours were benign. CONCLUSION The Association of Breast Surgery summary statement will reduce the number of fibroadenomas excised, but may also result in delayed diagnosis of some phyllodes tumours. Appropriate safety netting advice should be provided to identify rapidly growing lesions.
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Affiliation(s)
- Ahs Lee
- Nottingham University Hospitals NHS Trust, UK
| | - J James
- Breast Institute, Nottingham University Hospitals NHS Trust, UK
| | - L Whisker
- Breast Institute, Nottingham University Hospitals NHS Trust, UK
| | - E A Rakha
- Nottingham University Hospitals NHS Trust, UK
| | - I O Ellis
- Nottingham University Hospitals NHS Trust, UK
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11
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Ng CCY, Md Nasir ND, Loke BN, Tay TKY, Thike AA, Rajasegaran V, Liu W, Lee JY, Guan P, Lim AH, Chang KTE, Gudi MA, Madhukumar P, Tan BKT, Tan VKM, Wong CY, Yong WS, Ho GH, Ong KW, Yip GWC, Bay BH, Tan P, Teh BT, Tan PH. Genetic differences between benign phyllodes tumors and fibroadenomas revealed through targeted next generation sequencing. Mod Pathol 2021; 34:1320-1332. [PMID: 33727697 DOI: 10.1038/s41379-021-00787-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 12/14/2022]
Abstract
Breast fibroepithelial lesions are biphasic tumors which comprise the common benign fibroadenomas (FAs) and the rarer phyllodes tumors (PTs). This study analyzed 262 (42%) conventional FAs, 45 (7%) cellular FAs, and 321 (51%) benign PTs contributed by the International Fibroepithelial Consortium, using a previously curated 16 gene panel. Benign PTs were found to possess a higher number of mutations, and higher rates of cancer driver gene alterations than both groups of FAs, in particular MED12, TERT promoter, RARA, FLNA, SETD2, RB1, and EGFR. Cases with MED12 mutations were also more likely to have TERT promoter, RARA, SETD2, and EGFR. There were no significant differences detected between conventional FAs and cellular FAs, except for PIK3CA and MAP3K1. TERT promoter alterations were most optimal in discriminating between FAs and benign PTs. Our study affirms the role of sequencing and key mutations that may assist in refining diagnoses of these lesions.
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Affiliation(s)
- Cedric Chuan Young Ng
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore, Singapore
| | - Nur Diyana Md Nasir
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Benjamin Nathanael Loke
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Aye Aye Thike
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | | | - Wei Liu
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore, Singapore
| | - Jing Yi Lee
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore, Singapore
| | - Peiyong Guan
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore, Singapore.,Quantitative Biology and Medicine Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Abner Herbert Lim
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore, Singapore
| | - Kenneth Tou En Chang
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Mihir Ananta Gudi
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Preetha Madhukumar
- Division of Surgery and Surgical Oncology, National Cancer Center Singapore, Singapore, Singapore.,Department of Breast Surgery, Singapore General Hospital, Singapore, Singapore
| | - Benita Kiat Tee Tan
- Division of Surgery and Surgical Oncology, National Cancer Center Singapore, Singapore, Singapore.,Department of Breast Surgery, Singapore General Hospital, Singapore, Singapore.,Department of Surgery, Sengkang General Hospital, Singapore, Singapore
| | - Veronique Kiak Mien Tan
- Division of Surgery and Surgical Oncology, National Cancer Center Singapore, Singapore, Singapore.,Department of Breast Surgery, Singapore General Hospital, Singapore, Singapore
| | - Chow Yin Wong
- Division of Surgery and Surgical Oncology, National Cancer Center Singapore, Singapore, Singapore.,Department of Breast Surgery, Singapore General Hospital, Singapore, Singapore
| | - Wei Sean Yong
- Division of Surgery and Surgical Oncology, National Cancer Center Singapore, Singapore, Singapore.,Department of Breast Surgery, Singapore General Hospital, Singapore, Singapore
| | - Gay Hui Ho
- Division of Surgery and Surgical Oncology, National Cancer Center Singapore, Singapore, Singapore
| | - Kong Wee Ong
- Division of Surgery and Surgical Oncology, National Cancer Center Singapore, Singapore, Singapore
| | | | - George Wai Cheong Yip
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Boon Huat Bay
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Patrick Tan
- Duke-NUS Medical School, Singapore, Singapore
| | - Bin Tean Teh
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore, Singapore. .,Duke-NUS Medical School, Singapore, Singapore.
| | - Puay Hoon Tan
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore. .,Duke-NUS Medical School, Singapore, Singapore. .,Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. .,Division of Pathology, Singapore General Hospital, Singapore, Singapore.
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12
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Tan PH. Fibroepithelial lesions revisited: implications for diagnosis and management. Mod Pathol 2021; 34:15-37. [PMID: 32461622 DOI: 10.1038/s41379-020-0583-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/12/2020] [Accepted: 05/12/2020] [Indexed: 02/07/2023]
Abstract
Fibroepithelial lesions of the breast, comprising the fibroadenoma and phyllodes tumour, are a unique group of neoplasms that share histological characteristics but possess different clinical behaviour. The fibroadenoma is the commonest benign breast tumour in women, while the phyllodes tumour is rare and may be associated with recurrences, grade progression and even metastasis. The diagnosis of fibroadenoma is usually straightforward, with recognised histological variants such as the cellular, complex, juvenile and myxoid forms. The phyllodes tumour comprises benign, borderline and malignant varieties, graded using a constellation of histological parameters based on stromal characteristics of hypercellularity, atypia, mitoses, overgrowth and the nature of tumour borders. While phyllodes tumour grade correlates with clinical behaviour, interobserver variability in assessing multiple parameters that are potentially of different biological weightage leads to significant challenges in accurate grade determination and consequently therapy. Differential diagnostic considerations along the spectrum of fibroepithelial tumours can be problematic in routine practice. Recent discoveries of the molecular underpinnings of these tumours may have diagnostic, prognostic and therapeutic implications.
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Affiliation(s)
- Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Academia, Diagnostics Tower Level 7, 20 College Road, Singapore, 169856, Singapore.
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13
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Jackson J, Walker E, Bethune R, Bracey T, Mason C, Mandalia T. Extramammary Borderline Phyllodes Tumor Presenting as an Umbilical Mass. Int J Surg Pathol 2020; 29:648-652. [PMID: 33345669 DOI: 10.1177/1066896920981632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Phyllodes tumors (PTs) represent a spectrum of rare, fibroepithelial neoplasms of the breast, which can be subcategorized as benign, borderline, or malignant based on their histological appearance. Accessory breast tissue may present anywhere along the embryological mammary ridge, and at distant locations as aberrant breast tissue. We present the case of a 56-year-old lady with an umbilical mass, thought to represent a strangulated hernia. Sections showed a fibroepithelial tumor with leaf-like ducts, conspicuous mitotic activity (up to 8 per 10 high-power fields), and focal infiltration into fat. Immunohistochemical studies showed diffuse positivity of epithelial cells for estrogen receptor, mammaglobin, GCDFP-15, and CK7. These findings were consistent with a borderline PT. This is the first case report of PT presenting as an umbilical mass, and the first extramammary borderline PT described.
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14
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Lee B, Salibay CJ, Chong A, Ladd W, Eghtedari M, Ojeda-Fournier H. Fibroepithelial Lesions of the Breast: A Spectrum. CURRENT RADIOLOGY REPORTS 2020. [DOI: 10.1007/s40134-020-00373-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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15
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Srivastava V, Jha PK, Samhitha CV, Khanna S. Unusual Presentation of Benign Breast Disease in an Adolescent Girl. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02548-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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16
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Core needle biopsy diagnosis of fibroepithelial lesions of the breast: a diagnostic challenge. Pathology 2020; 52:627-634. [PMID: 32771211 DOI: 10.1016/j.pathol.2020.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/18/2020] [Accepted: 06/25/2020] [Indexed: 12/25/2022]
Abstract
Fibroepithelial lesions (FEL) of the breast are biphasic neoplasms consisting of proliferative epithelial and stromal components and include fibroadenoma, phyllodes tumour and periductal stromal tumour. Core needle biopsy (CNB) is a commonly used diagnostic modality for investigation of breast lesions. As the accurate diagnosis of FEL requires integrated assessment of both epithelial and stromal components, this may create problems in small biopsies with limited sampling. In this review, common problems encountered in CNB of FEL are discussed, including establishing a diagnosis of borderline/malignant phyllodes tumour in a biopsy consisting of malignant spindle cells, differentiating phyllodes tumour from fibroadenoma on CNB, grading of phyllodes tumour of intermediate histological grade and assessment of periductal stromal tumours. The approaches are detailed systematically based on histology, immunohistochemistry and molecular characterisation. This comprehensive approach may aid in dealing with the overlapping histological appearance of FEL and sampling limitations of CNB.
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Rivero LF, Graudenz MS, Aschton-Prolla P, Delgado AM, Kliemann LM. Accuracy of p53 and ki-67 in the graduation of phyllodes tumor, a model for practical application. SURGICAL AND EXPERIMENTAL PATHOLOGY 2020. [DOI: 10.1186/s42047-020-0058-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The accurate graduation of a phyllodes tumor (PT) is critical for effective treatment as it allows correct surgical management, and avoids inadequate excision for malignant or borderline PT, or surgical overtreatment in benign PT. PTs of the breast are notoriously difficult to classify, and reliable differentiation of a benign PT from a borderline or malignant PT can be problematic, especially among relatively inexperienced pathologists. Although several authors acknowledge a strong relationship between the immunohistochemical expression of p53 and Ki-67 and the histopathological grade of PT—with potential impact on diagnostic accuracy—the literature lacks consensus about which cutoff defines a positive index test. The objective of this study is to establish a practical application score that increases the graduation accuracy of PT through the appropriate use of these auxiliary methods.
Methods
A retrospective study cohort of 146 pathology reviewed PTs surgically removed between January 2000 and December 2015. The Ki-67 test was considered positive if > 10% of neoplastic cells showed nuclear staining. The p53 test was considered positive if > 10% of neoplastic nuclear cells showed nuclear staining in a moderate or strong intensity.
Results
Of the 146 PT cases reviewed, 110 were classified as benign, 16 as borderline, and 20 as malignant. The correlation between age and size with benign, borderline, and malignant subgroups was statistically significant (p < 0.001). Significance was observed in the expression of both Ki-67 and p53 in the comparison of benign, borderline, and malignant PT with p < 0.001 and a 95% confidence interval (CI). When correlating the presence of positivity in either of the two index tests with the diagnosis of borderline or malignant PT, we reached a sensitivity of 100% and a specificity of 91.8 (p < 0.001; 95% CI).
Conclusion
We propose a practical methodology to achieve an accurate grade of PT, based on clearly defined and easy to apply cutoffs of a simple immunohistochemical panel of Ki-67 and p53. A PT positive for either of the index tests should be graded as borderline or malignant, so pathologists can use this test to improve accuracy. We hope this new approach might provide the basis for the development of standardization in using p53 and Ki-67 for grading PT.
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Mberu V, Macaskill EJ, Purdie C, Evans A. Preoperative prediction of margin requirement following a core biopsy result suggestive of a phyllodes tumour. Clin Radiol 2019; 75:319.e21-319.e27. [PMID: 31862110 DOI: 10.1016/j.crad.2019.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/13/2019] [Indexed: 10/25/2022]
Abstract
AIM To determine if imaging features of lesions with a core biopsy suggestive of a phyllodes tumour can be used to identify which lesions require surgical excision with margins. MATERIALS AND METHODS Thirty-one lesions were identified from a prospective database of ultrasound visible masses. Demographic, mammographic, and ultrasound features were assessed while blinded to surgical outcome. Features of those lesions requiring a margin and those that did not were compared. Statistical significance was established using the chi-square test and receiver operating characteristic (ROC) curves. RESULTS Thirteen lesions (42%) required a margin and 18 lesions (58%) did not. Features found significantly more frequently in those requiring a margin were a poorly defined margin on mammography (7/9 [78%] versus 4/13 [31%]; p=0.04) and at ultrasound, an irregular margin (8/13 [62%] versus 3/18 [17%]; p=0.01), micro-lobulations (7/13 [54%] versus 3/18 [17%]; p=0.028), mixed echogenicity (9/13 [69%] versus 1/18 [6%]; p=0.0002), echogenic clefts (6/13 [46%] versus 1/18 [6%]; p=0.007), posterior enhancement (9/11 [82%] versus 6/18 [33%]; p=0.01), large size (p=0.003) and stiffness at shear-wave elastography (p=0.026). All six screen-detected lesions were benign. CONCLUSIONS There are multiple preoperative features that can be used to guide surgical management of lesions with a preoperative core biopsy result suggestive of a phyllodes tumour.
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Affiliation(s)
- V Mberu
- Department of Breast Imaging, School of Medicine, University of Dundee, Ninewells Hospital & Medical School, Dundee, DD1 9SY, UK
| | - E J Macaskill
- Department of Breast Surgery, Ninewells Hospital, NHS Tayside, James Arrott Dr, Dundee, DD2 1SY, UK
| | - C Purdie
- Department of Pathology, Ninewells Hospital, NHS Tayside, James Arrott Dr, Dundee, DD2 1SY, UK
| | - A Evans
- Department of Breast Imaging, School of Medicine, University of Dundee, Ninewells Hospital & Medical School, Dundee, DD1 9SY, UK.
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Rosa M, Agosto-Arroyo E. Core needle biopsy of benign, borderline and in-situ problematic lesions of the breast: Diagnosis, differential diagnosis and immunohistochemistry. Ann Diagn Pathol 2019; 43:151407. [PMID: 31634810 DOI: 10.1016/j.anndiagpath.2019.151407] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 08/22/2019] [Accepted: 09/02/2019] [Indexed: 12/11/2022]
Abstract
Core needle biopsy (CNB) is the most common sampling technique for the histologic evaluation of breast abnormalities. Diagnosing benign proliferative, borderline and some in-situ lesions in CNB is challenging and subject to a significant degree of interobserver variability. In addition, due to the inherent limitations of CNB, "upgrading" to a more significant pathology at excision is an important consideration for some lesions. Pathologists carry a major responsibility in patient diagnosis, risk stratification and management. Familiarity with the histologic features and the clinical significance of these common and problematic lesions encountered in CNB is necessary for adequate treatment and patient follow-up. This review will focus on benign, atypical and in-situ epithelial proliferations, papillary lesions, radial sclerosing lesions, adenosis and cellular fibroepithelial lesions. Highlights of histologic features, useful strategies for accurate diagnosis, basic immunohistochemistry and management will be presented.
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Affiliation(s)
- Marilin Rosa
- Department of Anatomic Pathology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, United States of America.
| | - Emmanuel Agosto-Arroyo
- Department of Anatomic Pathology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, United States of America.
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Ware AD, Argani P, Cimino-Mathews A. Accuracy and clinical implications of pre-operative breast core needle biopsy diagnoses of fibroepithelial neoplasms and sarcomatoid carcinomas. Breast Cancer Res Treat 2019; 178:51-56. [PMID: 31332664 DOI: 10.1007/s10549-019-05350-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/04/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE Accurate classification of breast phyllodes tumors (PTs) on core biopsy can be challenging. The differential diagnosis of benign PT (BP) is fibroadenoma (FA), whereas the differential diagnosis of malignant PT (MP) is sarcomatoid (metaplastic) carcinoma (SC). METHODS Here, we compare the pre-excision core biopsy diagnosis and clinicopathologic features of histologically confirmed MP, borderline PT (BLP), BP, FA, and SC. Consecutive cases of 34 histologically confirmed PT (14 MP, 10 BLP, 10 BP), 13 SC, and 10 FA were identified. RESULTS A core biopsy diagnosis of SC was made only in SC (77%, p = 0.003). The diagnosis "malignant neoplasm" or "atypical spindle cell neoplasm" was made in 100% MP and 23% SC, but no other tumor (p = 0.0001). The diagnosis "phyllodes tumor" was made only in PT (44% BLP, 11% BP, p = 0.06). The diagnosis "fibroepithelial lesion" was made in 44% BLP, 67% BP, and 29% FA. The diagnosis "FA" was made most commonly in FA (57%) (versus 22% BP and no other tumor; p = 0.002). Neoadjuvant therapy was given only in SC (23%, p = 0.03); adjuvant therapy was given in 46% SC and 13% MP (p = 0.04). CONCLUSIONS A pre-operative core biopsy diagnosis of "malignant spindle cell neoplasm" separates MP and SC from BLP, BP, and FA. However, MP and SC can have overlapping features on core biopsy. Thus, one must be careful not to overcall SC on core biopsy, as patients diagnosed with SC may receive neoadjuvant therapy. A core biopsy diagnosis of "phyllodes tumor" is specific for PT and can guide treatment planning of a wide local excision.
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Affiliation(s)
- Alisha D Ware
- The Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Pedram Argani
- The Departments of Pathology and Oncology, The Johns Hopkins Hospital, 401 N. Broadway St, Weinberg 2242, Baltimore, MD, 21287, USA
| | - Ashley Cimino-Mathews
- The Departments of Pathology and Oncology, The Johns Hopkins Hospital, 401 N. Broadway St, Weinberg 2242, Baltimore, MD, 21287, USA.
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Jung J, Kang E, Chae SM, Kim H, Park SY, Yun BL, Kim SM, Jang M, Kim SW, Kim EK. Development of a Management Algorithm for the Diagnosis of Cellular Fibroepithelial Lesions From Core Needle Biopsies. Int J Surg Pathol 2018; 26:684-692. [DOI: 10.1177/1066896918775525] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. Surgical excision is recommended for complete evaluation of cellular fibroepithelial lesions identified from core needle biopsy. The purpose of this study was to determine factors associated with phyllodes tumor among cellular fibroepithelial lesions from core biopsies and develop a scoring system to predict the risk of phyllodes tumor. Methods. We retrospectively reviewed clinical data of 169 breast lesions that were diagnosed as cellular fibroepithelial lesions from core needle biopsy at the Seoul National University Bundang Hospital between March 2005 and January 2013. The clinical, histopathologic, and radiologic characteristics were compared between phyllodes tumors and fibroadenomas during the final diagnosis after surgical excision. Results. Of the 169 lesions, 17 were observed and 152 were surgically removed. After excision, final pathology revealed 60 (39.5%) fibroadenomas and 92 (60.5%) phyllodes tumors. Multivariate analysis demonstrated that age (≥40 years), stromal overgrowth, and stromal cellularity were independent factors associated with phyllodes tumors. A scoring system was developed based on a multivariate logistic regression model, and the area under the receiver operating characteristic curve was 0.828 (95% confidence interval = 0.763-0.893). Conclusion. The scoring system will help clinicians make appropriate treatment for patients with cellular fibroepithelial lesions on core needle biopsy.
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Affiliation(s)
- Jaehag Jung
- Department of Surgery, Eulji University College of Medicine, Daejeon, Korea
| | - Eunyoung Kang
- Department of Surgery, Seoul National University College of Medicine, Seoul National University, Bundang Hospital, Seongnam, Korea
| | - Su Min Chae
- Department of Surgery, Seoul National University College of Medicine, Seoul National University, Bundang Hospital, Seongnam, Korea
| | - Hyojin Kim
- Department of Pathology, Seoul National University College of Medicine, Seoul National University, Bundang Hospital, Seongnam, Korea
| | - So Yeon Park
- Department of Pathology, Seoul National University College of Medicine, Seoul National University, Bundang Hospital, Seongnam, Korea
| | - Bo La Yun
- Department of Radiology, Seoul National University College of Medicine, Seoul National University, Bundang Hospital, Seongnam, Korea
| | - Sun Mi Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul National University, Bundang Hospital, Seongnam, Korea
| | - Mijung Jang
- Department of Radiology, Seoul National University College of Medicine, Seoul National University, Bundang Hospital, Seongnam, Korea
| | - Sung-Won Kim
- Department of Surgery, Daerim St. Mary’s Hospital, Seoul, Korea
| | - Eun-Kyu Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul National University, Bundang Hospital, Seongnam, Korea
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Dessauvagie BF, Lee AHS, Meehan K, Nijhawan A, Tan PH, Thomas J, Tie B, Treanor D, Umar S, Hanby AM, Millican-Slater R. Interobserver variation in the diagnosis of fibroepithelial lesions of the breast: a multicentre audit by digital pathology. J Clin Pathol 2018; 71:672-679. [DOI: 10.1136/jclinpath-2017-204977] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 01/23/2018] [Accepted: 01/24/2018] [Indexed: 11/03/2022]
Abstract
AimFibroepithelial lesions (FELs) of the breast span a morphological continuum including lesions where distinction between cellular fibroadenoma (FA) and benign phyllodes tumour (PT) is difficult. The distinction is clinically important with FAs managed conservatively while equivocal lesions and PTs are managed with surgery. We sought to audit core biopsy diagnoses of equivocal FELs by digital pathology and to investigate whether digital point counting is useful in clarifying FEL diagnoses.MethodScanned slide images from cores and subsequent excisions of 69 equivocal FELs were examined in a multicentre audit by eight pathologists to determine the agreement and accuracy of core needle biopsy (CNB) diagnoses and by digital point counting of stromal cellularity and expansion to determine if classification could be improved.ResultsInterobserver variation was high on CNB with a unanimous diagnosis from all pathologists in only eight cases of FA, diagnoses of both FA and PT on the same CNB in 15 and a ‘weak’ mean kappa agreement between pathologists (k=0.36). ‘Moderate’ agreement was observed on CNBs among breast specialists (k=0.44) and on excision samples (k=0.49). Up to 23% of lesions confidently diagnosed as FA on CNB were PT on excision and up to 30% of lesions confidently diagnosed as PT on CNB were FA on excision. Digital point counting did not aid in the classification of FELs.ConclusionAccurate and reproducible diagnosis of equivocal FELs is difficult, particularly on CNB, resulting in poor interobserver agreement and suboptimal accuracy. Given the diagnostic difficulty, and surgical implications, equivocal FELs should be reported in consultation with experienced breast pathologists as a small number of benign FAs can be selected out from equivocal lesions.
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Abstract
Fibroepithelial breast lesions encompass a heterogeneous group of neoplasms that range from benign to malignant, each exhibiting differing degrees of stromal proliferation in relation to the epithelial compartment. Fibroadenomas are common benign neoplasms that may be treated conservatively. Phyllodes tumors are relatively rare lesions, and classified as benign, borderline, or malignant based on histologic evaluation of various parameters. The diagnostic interpretation of "gray-zone" fibroepithelial lesions often imposes formidable demands on a pathologist's skills. This article offers practical recommendations for the diagnostic workup of these lesions, including the appropriate utilization of ancillary investigations and the approach to core needle biopsies.
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Maran-Gonzalez A. [Diagnostic challenges on breast needle core biopsies. Case 1: Low grade fibroepithelial neoplasm]. Ann Pathol 2017; 37:359-367. [PMID: 28943202 DOI: 10.1016/j.annpat.2017.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 08/08/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Aurélie Maran-Gonzalez
- Service d'anatomie pathologique, ICM val d'Aurelle, Parc Euromédecine, 208, rue des Apothicaires, 34298 Montpellier cedex 5, France.
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Strode M, Khoury T, Mangieri C, Takabe K. Update on the diagnosis and management of malignant phyllodes tumors of the breast. Breast 2017; 33:91-96. [DOI: 10.1016/j.breast.2017.03.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 02/27/2017] [Accepted: 03/01/2017] [Indexed: 01/31/2023] Open
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Abstract
Fibroepithelial lesions of the breast comprise a morphologically and biologically heterogeneous group of biphasic tumors with epithelial and stromal components that demonstrate widely variable clinical behavior. Fibroadenomas are common benign tumors with a number of histologic variants, most of which pose no diagnostic challenge. Cellular and juvenile fibroadenomas can have overlapping features with phyllodes tumors and should be recognized. Phyllodes tumors constitute a spectrum of lesions with varying clinical behavior and are graded as benign, borderline or malignant based on a set of histologic features according to recommendations by the World Health Organization (WHO). Recent developments have significantly expanded our understanding of the pathogenesis of fibroepithelial lesions, highlighting fibroadenomas as true neoplasms and underscoring a commonality with phyllodes tumors in the form of recurrent MED12 exon 2 mutations. In addition, sequencing studies have elucidated pathways associated with phyllodes tumor progression. Accurate diagnosis and grading of phyllodes tumors are important for patient management and prognosis, as grade broadly correlates with increasing local recurrence risk, and essentially only malignant tumors metastasize. However, classification of fibroepithelial lesions in many cases remains challenging on both core biopsy and excision specimens. A commonly encountered problem at the benign end of the spectrum is the distinction of benign phyllodes tumor from cellular fibroadenoma, which is largely due to the subjective nature of histologic features used in diagnosis and histologic overlap between lesions. Grading is further complicated by the requirement to integrate multiple subjective and ill-defined parameters. On the opposite end of the histologic spectrum, malignant phyllodes tumors must be distinguished from more common metaplastic carcinomas and from primary or metastatic sarcomas, which can be especially difficult in core biopsies. Immunohistochemistry can be useful in the differential diagnosis but should be interpreted with attention to caveats. This review provides an overview and update on the spectrum of fibroepithelial lesions, with special emphasis on common problems and practical issues in diagnosis.
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Affiliation(s)
- Gregor Krings
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA.
| | - Gregory R Bean
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Yunn-Yi Chen
- Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA
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Kim GR, Choi JS, Han BK, Ko EY, Ko ES, Hahn SY. Combination of shear-wave elastography and color Doppler: Feasible method to avoid unnecessary breast excision of fibroepithelial lesions diagnosed by core needle biopsy. PLoS One 2017; 12:e0175380. [PMID: 28472030 PMCID: PMC5417487 DOI: 10.1371/journal.pone.0175380] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 03/26/2017] [Indexed: 11/24/2022] Open
Abstract
Background We evaluated shear-wave elastography (SWE) and color Doppler ultrasonography (US) features for fibroepithelial lesions (FELs), and to evaluate their utility to differentiate fibroadenomas (FAs) and phyllodes tumors (PTs). Methods This retrospective study included 67 FELs pathologically confirmed (49 FAs, 18 PTs). B-mode US, SWE and color Doppler US were performed for each lesion. Mean elasticity (Emean), maximum elasticity (Emax), and vascularity were determined by SWE and Doppler US. Diagnostic performances were calculated to differentiate FAs and PTs. Equivocal FELs diagnosed by core needle biopsy (CNB) were further analyzed. Results Median Emean and Emax were significantly lower for FAs than PTs (Emean, 15.7 vs. 66.7 kPa; Emax, 21.0 vs. 76.7 kPa, P<0.01). Low vascularity (0–1 vessel flow) on color Doppler US were more frequent in FAs than in PTs (P<0.01). SWE showed significantly higher specificities (Emean >43.9 kPa, 89.8%; Emax >46.1 kPa, 79.6%) than B-mode US (42.9%) (P<0.01) for differentiating PTs from FAs. Other diagnostic values of SWE and overall diagnostic values of Doppler US were not significantly different from B-mode US (P>0.05). The combination of SWE and Doppler US with ‘Emean>43.9 kPa or high vascularity (≥2 vessel flows)’ showed a higher area under the curve (0.786 vs. 0.687) and higher diagnostic values than B-mode US (sensitivity, 100 vs. 94.4%; specificity, 57.1 vs. 42.9%; positive predictive value, 46.2 vs. 37.8%; negative predictive value, 100 vs. 95.5%), without statistical significance (P>0.05). Of the 30 equivocal FELs, all lesions with ‘Emean≤43.9 kPa and low vascularity (0–1 vessel flow)’ (23.3%, 7/30) were finally confirmed as FAs by excision. Conclusion FAs have a tendency to have less stiffness and lower vascularity than PTs. Combined SWE and color Doppler US may help patients with equivocal FELs diagnosed by CNB avoid unnecessary excision.
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Affiliation(s)
- Ga Ram Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Radiology, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea
| | - Ji Soo Choi
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- * E-mail:
| | - Boo-Kyung Han
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Young Ko
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Sook Ko
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Soo Yeon Hahn
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Zhang Y, Kleer CG. Phyllodes Tumor of the Breast: Histopathologic Features, Differential Diagnosis, and Molecular/Genetic Updates. Arch Pathol Lab Med 2017; 140:665-71. [PMID: 27362571 DOI: 10.5858/arpa.2016-0042-ra] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT -Phyllodes tumor (PT) of the breast is a rare fibroepithelial neoplasm with risks of local recurrence and uncommon metastases. The classification proposed by the World Health Organization for PTs into benign, borderline, and malignant is based on a combination of several histologic features. The differential diagnosis between PT and fibroadenoma and the histologic grading of PT remain challenging. In addition, the molecular pathogenesis of PT is largely unknown. OBJECTIVE -To provide an updated overview of pathologic features, diagnostic terminology, and molecular alterations of PT. DATA SOURCES -Current English literature related to PT of the breast. CONCLUSIONS -Phyllodes tumor shows a wide spectrum of morphology. There are no clearly distinct boundaries between PT and fibroadenoma. Strict histologic assessment of a combination of histologic features with classification can help to achieve the correct diagnosis and provide useful clinical information. The genomic landscapes of PT generated from genomic sequencing provide insights into the molecular pathogenesis of PT and help to improve diagnostic accuracy and identify potential drug targets in malignant PT.
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Affiliation(s)
- Yanhong Zhang
- From the Department of Pathology and Laboratory Medicine, University of California, Davis Medical Center, Sacramento (Dr Zhang); and the Department of Pathology, University of Michigan, Ann Arbor (Dr Kleer)
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Loane J. Comment on: Tan WJ, Cima I, Choudhury Y, Wei X, Lim JCT, Thicke AA, Tan MH, Tan PH. A five-gene reverse transcription-PCR assay for pre-operative classification of breast fibroepithelial lesions. Breast Cancer Research 2016;18:31. Breast Cancer Res 2016; 18:77. [PMID: 27456960 PMCID: PMC4959056 DOI: 10.1186/s13058-016-0730-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Joseph Loane
- Western General Hospital, Crewe Road, Edinburgh, UK.
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Tan WJ, Cima I, Choudhury Y, Wei X, Lim JCT, Thike AA, Tan MH, Tan PH. A five-gene reverse transcription-PCR assay for pre-operative classification of breast fibroepithelial lesions. Breast Cancer Res 2016; 18:31. [PMID: 26961242 PMCID: PMC4784364 DOI: 10.1186/s13058-016-0692-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 02/25/2016] [Indexed: 11/30/2022] Open
Abstract
Background Breast fibroepithelial lesions are biphasic tumors and include fibroadenomas and phyllodes tumors. Preoperative distinction between fibroadenomas and phyllodes tumors is pivotal to clinical management. Fibroadenomas are clinically benign while phyllodes tumors are more unpredictable in biological behavior, with potential for recurrence. Differentiating the tumors may be challenging when they have overlapping clinical and histological features especially on core biopsies. Current molecular and immunohistochemical techniques have a limited role in the diagnosis of breast fibroepithelial lesions. We aimed to develop a practical molecular test to aid in distinguishing fibroadenomas from phyllodes tumors in the pre-operative setting. Methods We profiled the transcriptome of a training set of 48 formalin-fixed, paraffin-embedded fibroadenomas and phyllodes tumors and further designed 43 quantitative polymerase chain reaction (qPCR) assays to verify differentially expressed genes. Using machine learning to build predictive regression models, we selected a five-gene transcript set (ABCA8, APOD, CCL19, FN1, and PRAME) to discriminate between fibroadenomas and phyllodes tumors. We validated our assay in an independent cohort of 230 core biopsies obtained pre-operatively. Results Overall, the assay accurately classified 92.6 % of the samples (AUC = 0.948, 95 % CI 0.913–0.983, p = 2.51E-19), with a sensitivity of 82.9 % and specificity of 94.7 %. Conclusions We provide a robust assay for classifying breast fibroepithelial lesions into fibroadenomas and phyllodes tumors, which could be a valuable tool in assisting pathologists in differential diagnosis of breast fibroepithelial lesions. Electronic supplementary material The online version of this article (doi:10.1186/s13058-016-0692-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wai Jin Tan
- Division of Biodevices and Diagnostics, Institute of Bioengineering and Nanotechnology, 31 Biopolis Way, The Nanos, #04-01, Singapore, 138669, Republic of Singapore.
| | - Igor Cima
- Division of Biodevices and Diagnostics, Institute of Bioengineering and Nanotechnology, 31 Biopolis Way, The Nanos, #04-01, Singapore, 138669, Republic of Singapore.
| | - Yukti Choudhury
- Division of Biodevices and Diagnostics, Institute of Bioengineering and Nanotechnology, 31 Biopolis Way, The Nanos, #04-01, Singapore, 138669, Republic of Singapore.
| | - Xiaona Wei
- Division of Biodevices and Diagnostics, Institute of Bioengineering and Nanotechnology, 31 Biopolis Way, The Nanos, #04-01, Singapore, 138669, Republic of Singapore.
| | - Jeffrey Chun Tatt Lim
- Department of Pathology, Singapore General Hospital, 20 College Road, Academia, Level 7, Diagnostics Tower, Singapore, 169856, Republic of Singapore.
| | - Aye Aye Thike
- Department of Pathology, Singapore General Hospital, 20 College Road, Academia, Level 7, Diagnostics Tower, Singapore, 169856, Republic of Singapore.
| | - Min-Han Tan
- Division of Biodevices and Diagnostics, Institute of Bioengineering and Nanotechnology, 31 Biopolis Way, The Nanos, #04-01, Singapore, 138669, Republic of Singapore.
| | - Puay Hoon Tan
- Department of Pathology, Singapore General Hospital, 20 College Road, Academia, Level 7, Diagnostics Tower, Singapore, 169856, Republic of Singapore. .,Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Republic of Singapore.
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Edwards T, Jaffer S, Szabo JR, Sonnenblick EB, Margolies LR. Cellular fibroadenoma on Core needle biopsy: management recommendations for the radiologist. Clin Imaging 2016; 40:587-90. [PMID: 27317201 DOI: 10.1016/j.clinimag.2016.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 01/31/2016] [Accepted: 02/11/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Cellular fibroadenomas (CFA) are difficult to distinguish from phyllodes tumor (PT) at biopsy. This study's purpose was to determine what CFA characteristics were associated with recommendations to follow-up or excise and if the current algorithm was correct. MATERIALS AND METHODS Databases from 2002 to 2014 were reviewed. Mass characteristics and post biopsy recommendations were recorded. RESULTS 81 CFAs were diagnosed; 19 cellular and 62 with slightly cellular stroma. 21 masses were surgically excised with 2 PTs diagnosed. CONCLUSION Larger mass size and increased histologic cellularity were associated with excision recommendation, but only clinical growth was associated with PT.
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Affiliation(s)
- Teresa Edwards
- Department of Radiology, Icahn School of Medicine at Mount Sinai
| | - Shabnam Jaffer
- Department of Pathology, Icahn School of Medicine at Mount Sinai
| | - Janet R Szabo
- Department of Radiology, Icahn School of Medicine at Mount Sinai
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Can problematic fibroepithelial lesions be accurately classified on core needle biopsies? Hum Pathol 2016; 47:38-44. [DOI: 10.1016/j.humpath.2015.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 08/21/2015] [Accepted: 09/02/2015] [Indexed: 11/16/2022]
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Tay TKY, Chang KTE, Thike AA, Tan PH. Paediatric fibroepithelial lesions revisited: pathological insights. J Clin Pathol 2015; 68:633-41. [DOI: 10.1136/jclinpath-2015-202956] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 04/23/2015] [Indexed: 11/04/2022]
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Soofi Y, Khoury T. Inter-Institutional Pathology Consultation: The Importance of Breast Pathology Subspecialization in a Setting of Tertiary Cancer Center. Breast J 2015; 21:337-44. [DOI: 10.1111/tbj.12420] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Yousef Soofi
- Department of Pathology; Roswell Park Cancer Institute; Buffalo New York
| | - Thaer Khoury
- Department of Pathology; Roswell Park Cancer Institute; Buffalo New York
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Yasir S, Gamez R, Jenkins S, Visscher DW, Nassar A. Significant histologic features differentiating cellular fibroadenoma from phyllodes tumor on core needle biopsy specimens. Am J Clin Pathol 2014; 142:362-9. [PMID: 25125627 DOI: 10.1309/ajcpzuz96resgpup] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES Cellular fibroepithelial lesions (CFELs) are a heterogeneous group of tumors encompassing cellular fibroadenoma (CFA) and phyllodes tumor (PT). Distinction between the two is challenging on core needle biopsy (CNB) specimens. The objective of this study was to evaluate histologic features that can help distinguish PT from CFA on CNB specimens. METHODS Records of all patients diagnosed with CFELs on CNB specimens with follow-up excision between January 2002 and December 2012 were retrieved. Histopathologic stromal features were evaluated on CNB specimens, including mitoses per 10 high-power fields (hpf), overgrowth, increased cellularity, fragmentation, adipose tissue infiltration, heterogeneity, subepithelial condensation, and nuclear pleomorphism. RESULTS Twenty-seven (42.2%) of 64 were diagnosed as PT (24 benign PTs and three borderline PTs) and 37 (57.8%) as CFA on excision. All features except for increased stromal cellularity were statistically significant. The average number of histologic features seen in PT and CFA was 3.9 and 1.4, respectively (odds ratio [OR], 7.27; 95% confidence interval [CI], 2.44-21.69; P = .0004). The average number of mitoses per 10 hpf was 3.0 for PT compared with 0.8 for CFA (OR, 2.14; 95% CI, 1.18-3.86; P = .01). CONCLUSIONS The presence of mitoses (three or more) and/or total histologic features of three or more on CNB specimens were the most helpful features in predicting PT on excision.
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Affiliation(s)
- Saba Yasir
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Roberto Gamez
- Department of Pathology and Laboratory Medicine, Loyola University, Chicago, IL
| | - Sarah Jenkins
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Daniel W. Visscher
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Aziza Nassar
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL
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Abdulcadir D, Nori J, Meattini I, Giannotti E, Boeri C, Vanzi E, Vezzosi V, Bianchi S. Phyllodes tumours of the breast diagnosed as B3 category on image-guided 14-gauge core biopsy: analysis of 51 cases from a single institution and review of the literature. Eur J Surg Oncol 2014; 40:859-64. [PMID: 24612651 DOI: 10.1016/j.ejso.2014.02.222] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 01/08/2014] [Accepted: 02/07/2014] [Indexed: 10/25/2022] Open
Abstract
AIMS Image-guided 14-gauge (G) core biopsy (CB) has been shown to be an accurate method providing histological diagnosis of breast lesions. The purpose of this study was to evaluate the reliability of image-guided 14-G CB in the diagnosis of phyllodes tumours (PT) reported as B3 category and its accuracy in distinguishing this lesion from fibroadenomas (FA). MATERIALS AND METHODS The records of 10 000 image-guided 14-G CB of the breast performed from January 2001 to August 2011 at the Diagnostic Senology Unit of Careggi University Hospital were reviewed; 2554 (25.5%) were fibroepithelial lesions: 56 of them (2%) were diagnosed as PT and reported as B3 category. The database of the Pathological Anatomy Unit of Careggi University Hospital was then searched to verify the histological diagnosis after surgical excision. Fifty-one cases of PT diagnosed as B3 category in 51 women were included in the present study. RESULTS Of the 51 cases of PT diagnosed as B3 category on 14-G CB, 39 (76.5%) lesions were confirmed as PT on SE (30, 4 and 5 as benign, borderline and malignant PT respectively) with a PPV of 76.5%. Twelve lesions (23.5%) were diagnosed as FA after surgical excision. CONCLUSIONS Our study shows that 14-G CB is a valuable tool, in a preoperative setting, in diagnosing PT.
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Affiliation(s)
- D Abdulcadir
- Diagnostic Senology Unit, AOU Careggi, Largo GA Brambilla 3, 50134 Florence, Italy.
| | - J Nori
- Diagnostic Senology Unit, AOU Careggi, Largo GA Brambilla 3, 50134 Florence, Italy
| | - I Meattini
- Radiotherapy Unit, Clinical Physiopathology Department, AOU Careggi, Largo GA Brambilla 3, 50134 Florence, Italy
| | - E Giannotti
- Diagnostic Senology Unit, AOU Careggi, Largo GA Brambilla 3, 50134 Florence, Italy
| | - C Boeri
- Diagnostic Senology Unit, AOU Careggi, Largo GA Brambilla 3, 50134 Florence, Italy
| | - E Vanzi
- Diagnostic Senology Unit, AOU Careggi, Largo GA Brambilla 3, 50134 Florence, Italy
| | - V Vezzosi
- Pathological Anatomy Unit, Department of Surgery and Translational Medicine, AOU Careggi, Largo GA Brambilla 3, 50134 Florence, Italy
| | - S Bianchi
- Pathological Anatomy Unit, Department of Surgery and Translational Medicine, AOU Careggi, Largo GA Brambilla 3, 50134 Florence, Italy
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Yang X, Kandil D, Cosar EF, Khan A. Fibroepithelial tumors of the breast: pathologic and immunohistochemical features and molecular mechanisms. Arch Pathol Lab Med 2014; 138:25-36. [PMID: 24377809 DOI: 10.5858/arpa.2012-0443-ra] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT The 2 main prototypes of fibroepithelial tumors of the breast include fibroadenoma and phyllodes tumor (PT). Although both tumors share some overlapping histologic features, there are significant differences in their clinical behavior and management. Phyllodes tumors have been further divided into clinically relevant subtypes, and there is more than one classification scheme for PT currently in use, suggesting a lack of consistency within different practices. Accurate differentiation between fibroadenoma and PT, as well as the grading of PT, may sometimes be challenging on preoperative core needle biopsy. Some immunohistochemical markers have been suggested to aid in the pathologic classification of these lesions. OBJECTIVE To discuss the salient histopathologic features of fibroepithelial tumors and review the molecular pathways proposed for the initiation, progression, and metastasis of PTs. Also, to provide an update on immunohistochemical markers that may be useful in their differential diagnosis and outline the practice and experience at our institution from a pathologic perspective. DATA SOURCES Sources included published articles from peer-reviewed journals in PubMed (US National Library of Medicine). CONCLUSIONS Fibroepithelial tumor of the breast is a heterogenous group of lesions ranging from fibroadenoma at the benign end of the spectrum to malignant PT. There are overlapping histologic features among various subtypes, and transformation and progression to a more malignant phenotype may also occur. Given the significant clinical differences within various subtypes, accurate pathologic classification is important for appropriate management. Although some immunohistochemical markers may be useful in this differential diagnosis, histomorphology still remains the gold standard.
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Affiliation(s)
- Xiaofang Yang
- From the Department of Pathology, University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester
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39
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Li LJ, Zeng H, Ou B, Luo BM, Xiao XY, Zhong WJ, Zhao XB, Zhao ZZ, Yang HY, Zhi H. Ultrasonic elastography features of phyllodes tumors of the breast: a clinical research. PLoS One 2014; 9:e85257. [PMID: 24454830 PMCID: PMC3893177 DOI: 10.1371/journal.pone.0085257] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 11/25/2013] [Indexed: 12/21/2022] Open
Abstract
The purpose of this study was to analyze the ultrasonic elastography features of phyllodes tumors of the breast comparing with fibroadenomas. A retrospective database was queried for the patients diagnosed as phyllodes tumors and fibroadenomas at Sun Yat-sen Memorial Hospital from January 2008 to August 2012. Three hundred and fifty lesions from 323 consecutive patients were included in the study. All the cases were examined by conventional ultrasonography and ultrasound elastography. Ultrasound elastography was used to calculate strain ratio of the lesions with bilateral breast tissue at the same depth as reference. There were 36 phyllodes tumors (27 benign, 8 borderline, 1 malignant) and 314 fibroadenomas (158 the pericanalicular type, 103 the intracanalicular type, 53 other special types). The strain ratio for phyllodes tumors (3.19±2.33) was significantly higher than for fibroadenomas (1.69±0.88) (p<0.05). The Spearman.s correlation coefficient between strain ratio of ultrasound elastography and pathological groups was significant, with a value of 0.17 (p<0.05). Ultrasound elastography could provide additional information to differentiate phyllodes tumors from fibroadenoma in breast.
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Affiliation(s)
- Lu-Jing Li
- Department of Ultrasound, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Hong Zeng
- Department of Pathology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Bing Ou
- Department of Ultrasound, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
- * E-mail: (BO); (H. Zhi)
| | - Bao-Ming Luo
- Department of Ultrasound, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiao-Yun Xiao
- Department of Ultrasound, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wen-Jing Zhong
- Department of Ultrasound, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xin-Bao Zhao
- Department of Ultrasound, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zi-Zhuo Zhao
- Department of Ultrasound, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Hai-Yun Yang
- Department of Ultrasound, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Hui Zhi
- Department of Ultrasound, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
- * E-mail: (BO); (H. Zhi)
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Ward S, Jewkes A, Jones B, Chaudhri S, Hejmadi R, Ismail T, Hallissey M. The sensitivity of needle core biopsy in combination with other investigations for the diagnosis of phyllodes tumours of the breast. Int J Surg 2012; 10:527-31. [DOI: 10.1016/j.ijsu.2012.08.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 08/02/2012] [Accepted: 08/06/2012] [Indexed: 10/28/2022]
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Choi J, Koo JS. Comparative study of histological features between core needle biopsy and surgical excision in phyllodes tumor. Pathol Int 2011; 62:120-6. [DOI: 10.1111/j.1440-1827.2011.02761.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tsang AKH, Chan SK, Lam CCF, Lui PCW, Chau HHL, Tan PH, Tse GM. Phyllodes tumours of the breast - differentiating features in core needle biopsy. Histopathology 2011; 59:600-8. [DOI: 10.1111/j.1365-2559.2011.03939.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Resetkova E, Khazai L, Albarracin CT, Arribas E. Clinical and radiologic data and core needle biopsy findings should dictate management of cellular fibroepithelial tumors of the breast. Breast J 2011; 16:573-80. [PMID: 21070433 DOI: 10.1111/j.1524-4741.2010.01013.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Fibroepithelial lesions with cellular stroma identified on core needle biopsy (CNB) may prove to be either fibroadenoma or phyllodes tumor at excision; therefore, management of these rare lesions is highly controversial. We aim to assess the management and the outcome of 101 cellular fibroepithelial lesions diagnosed on CNB over a 6-year period in one institution. Consensus on clinical management in each individual patient was reached during multi-disciplinary conferences, based on careful correlation of clinical data with results of imaging studies and pathology of CNB samples. Radiologic findings (mammogram and sonogram) and multiple histologic parameters on CNB specimen were blindly re-evaluated by one experienced breast radiologist and two breast pathologists, respectively, and results were correlated with final diagnosis at excision. Cellular fibroepithelial lesions with indeterminate or suspect imaging findings, with larger size, and with an equivocal comment such as "cannot rule out phyllodes tumor" in the pathology report were excised more frequently (p = 0.05, p = 0.034, and p = 0.01, respectively). Of 43 excised lesions, 13 were classified as benign phyllodes tumors, 23 as fibroadenoma and seven as benign cellular fibroepithelial lesion. The final diagnosis at excision did not significantly correlate with any clinical data, or with retrospective evaluation of imaging findings or comprehensive evaluation of multiple histologic parameters. In 58 patients who had clinical and radiologic follow-up (mean ± SD: 30 ± 21 months) there was no evidence of disease progression. No clinical and radiologic findings and/or comprehensive evaluation of multiple histologic parameters on CNB specimen are distinctive enough to predict final classification of equivocal cellular fibroepithelial lesions. However, careful clinico-pathologic and radiologic correlation may help to select the most clinically significant lesions for proper immediate surgical management. Follow-up alone may be an appropriate alternative for a subset of patients, given a good clinical, pathologic, and radiologic correlation.
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Affiliation(s)
- Erika Resetkova
- Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA.
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Molleran V. Postbiopsy management. Semin Roentgenol 2010; 46:40-50. [PMID: 21134527 DOI: 10.1053/j.ro.2010.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Virginia Molleran
- Breast Imaging Department, UC Health/University Hospital, Cincinnati, OH, USA.
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45
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Jara-Lazaro AR, Akhilesh M, Thike AA, Lui PCW, Tse GMK, Tan PH. Predictors of phyllodes tumours on core biopsy specimens of fibroepithelial neoplasms. Histopathology 2010; 57:220-32. [DOI: 10.1111/j.1365-2559.2010.03607.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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46
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Abstract
Core needle biopsy (CNB) is increasingly being used in the investigation of breast disease whether this is asymptomatic and suspected after screening mammography, or presents symptomatically in the patient. In most cases, the result of the procedure provides a definitive diagnosis or at least provides information that is used to plan the further management of the patient. There are, however, a number of unresolved issues with the use of CNB; for example, with regard to the amount of information that can be reliably derived from CNB or with regard to the management of the patient after some CNB diagnoses. Oestrogen and progesterone receptors and HER2 are reported on both core biopsies and excision specimens, but there continues to be debate over which represents the more appropriate specimen type on which to perform these tests. There are a number of possible diagnoses after CNB for which the management is not straightforward and around which there may be controversy, or just a lack of sufficient evidence to support a definite management plan. These 'lesions of uncertain malignant potential' include papillary lesions, fibroepithelial lesions with cellular stroma, mucocoele-like lesions and radial scars. Currently, these are removed surgically but there may be an argument for more conservative management including vacuum-assisted core excision in some cases.
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47
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Go EML, Chan SK, Vong JSL, Lui PCW, Chan AWH, Ma TKF, Ang MA, Law BKB, Tan PH, Tse GM. Predictors of invasion in needle core biopsies of the breast with ductal carcinoma in situ. Mod Pathol 2010; 23:737-42. [PMID: 20081814 DOI: 10.1038/modpathol.2009.187] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A significant proportion of ductal carcinomas in situ (DCISs) of the breast diagnosed on core biopsies had invasion upon excision. An assessment of various invasion predictors in the biopsies yielded conflicting results. A cohort of 157 cases with needle core biopsy diagnosed with DCISs (including 109 histologically proven DCISs, and 48 cases with invasion upon excision) were evaluated for the numbers of positive and total cores, the percentage of positivity, lobular cancerization, tumor nuclear grade, necrosis, calcification, predominate histological pattern, lymphocytic infiltrate and excisional tumor size. The mean positive core percentage and excisional tumor size were 76% and 2.8 cm for invasive and 66% and 1.9 cm for noninvasive groups. In the biopsy of the invasive group, cancerization of lobules was present in 52%, and nuclear grades 1, 2 and 3 were present in 31, 31 and 38%, respectively. Large comedo and small noncomedo necroses were present in 48 and 10%, whereas large and small calcifications were present in 16 and 21%. Solid, cribriform and papillary patterns were observed in 88, 38 and 21%, respectively. Moderate to marked lymphoid infiltrate was present in 31%. In the biopsy of the noninvasive group, cancerization of lobules was present in 69%, and the nuclear grades 1, 2 and 3 were present in 23, 48 and 29%, respectively. Large comedo and small noncomedo necroses were present in 35 and 11%, whereas large and small calcifications were present in 33 and 23%. Solid, cribriform and papillary patterns were observed in 85, 39 and 9%, respectively. Moderate to marked lymphoid infiltrate was present in 36%. Comparing these groups, a higher positive core percentage, papillary pattern and less cancerization of lobules in the cores and larger excisional tumor size were associated with a higher chance of invasion. Calcification, necrosis and nuclear grade were not significant invasion predictors.
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Affiliation(s)
- Edna May L Go
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
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Morgan JM, Douglas-Jones AG, Gupta SK. Analysis of histological features in needle core biopsy of breast useful in preoperative distinction between fibroadenoma and phyllodes tumour. Histopathology 2010; 56:489-500. [DOI: 10.1111/j.1365-2559.2010.03514.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Reisenbichler ES, Krontiras H, Hameed O. Βeta-Human Chorionic Gonadotropin Production Associated with Phyllodes Tumor of the Breast: An Unusual Paraneoplastic Phenomenon. Breast J 2009; 15:527-30. [DOI: 10.1111/j.1524-4741.2009.00772.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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50
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MacGrogan G. [Diagnostic pitfalls in mammary pathology. Case 3. Fibroepithelial tumor with hypercellular stroma, suggestive of phyllodes tumor]. Ann Pathol 2009; 29:199-204. [PMID: 19619826 DOI: 10.1016/j.annpat.2009.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2009] [Indexed: 10/20/2022]
Affiliation(s)
- Gaëtan MacGrogan
- Service d'anatomie pathologique, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux, France.
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