Accuracy and clinical implications of pre-operative breast core needle biopsy diagnoses of fibroepithelial neoplasms and sarcomatoid carcinomas

Ware, Alisha D.; Argani, Pedram; Cimino‐Mathews, Ashley

doi:10.1007/s10549-019-05350-5

Cited by 5 publications

(6 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, the clinical and imaging presentations and the immunoprofiles of these 2 entities differ, and strong CD34 positivity of stromal cells in phyllodes tumor rules out FLMC 129. Some have found that CD34 loses expression intensity, either partially, focally, or wholly, with increasing grade, a finding, however, which should not impact the differential,53,130 whereas other markers commonly used in the workup, such as p63 and p40, may be expressed focally in malignant phyllodes tumor,131 as can SMA, desmin,129 ER and PR,130 nuclear β-catenin,46 and keratins 132,133…”

Section: Miscellaneousmentioning

confidence: 99%

Low to Intermediate (Borderline) Grade Breast Spindle Cell Lesions on Needle Biopsy: Diagnostic Approach and Clinical Management

Russell

Montgomery²,

Susnik³

2022

Advances in Anatomic Pathology

View full text Add to dashboard Cite

Spindle cell proliferations of the breast are a heterogeneous group of lesions ranging from benign or reactive lesions to aggressive malignant neoplasms. Diagnosis on core biopsy can be particularly challenging as lesions displaying different lineages associated with variable outcomes share overlapping morphologies (scar vs. fibromatosis-like metaplastic carcinoma) whereas individual entities can exhibit a large variety of appearances (myofibroblastoma). In this review, lesions are grouped into lineage, when possible, including those showing fibroblastic/myofibroblastic differentiation, ranging from entities that require no additional management, such as scar and nodular fasciitis, to those with unpredictable clinical outcomes such as fibromatosis and solitary fibrous tumor or locally aggressive behavior such as dermatofibrosarcoma protuberans. The review of low-grade vascular lesions includes atypical vascular lesion and low-grade angiosarcoma. Also discussed are various adipocytic lesions ranging from lipoma to liposarcoma, and rare smooth muscle and neural entities more commonly encountered in locations outside the breast, such as leiomyoma, neurofibroma, schwannoma, or granular cell tumor. Optimal histological evaluation of these entities merges clinical and radiologic data with morphology and ancillary testing. We present our approach to immunohistochemical and other ancillary testing and highlight issues in pathology correlation with imaging. Recent updates in the management of breast spindle cell lesions are addressed. In a well-sampled lesion with radiographic concordance, the core biopsy diagnosis reliably guides management and we advocate the inclusion of management recommendations in the pathology report. Precise characterization using up to date guidelines is important to identify a subset of patients who may safely avoid unnecessary surgical procedures. A multidisciplinary approach with close collaboration with our clinical colleagues is emphasized.

show abstract

Section: Miscellaneousmentioning

confidence: 99%

Low to Intermediate (Borderline) Grade Breast Spindle Cell Lesions on Needle Biopsy: Diagnostic Approach and Clinical Management

Russell

Montgomery²,

Susnik³

2022

Advances in Anatomic Pathology

View full text Add to dashboard Cite

show abstract

“…For decades, surgical resection has been the standard initial treatment for mammary SCP. In the modern era of minimally invasive therapy, there is an emerging trend to manage nonovertly malignant breast lesions conservatively 9–12 . One such example is mammary fibromatosis, in which the breast is regarded as a favorable site, and management by nonsurgical/surveillance approach is becoming the primary line of management 13–17 .…”

mentioning

confidence: 99%

“…In the modern era of minimally invasive therapy, there is an emerging trend to manage nonovertly malignant breast lesions conservatively. [9][10][11][12] One such example is mammary fibromatosis, in which the breast is regarded as a favorable site, and management by nonsurgical/surveillance approach is becoming the primary line of management. [13][14][15][16][17] We hypothesize that many SCP may be accurately diagnosed on CNB and may be treated conservatively with surveillance, provided there is an appropriate clinicopathologic correlation.…”

mentioning

confidence: 99%

Mammary Spindle Cell Proliferations on Core Needle Biopsy

Pun

Turashvili

Mulligan

et al. 2023

American Journal of Surgical Pathology

View full text Add to dashboard Cite

Mammary spindle cell proliferations (SCPs) encompass a wide range of lesions and can be challenging to accurately diagnose on core needle biopsies (CNBs). Most SCPs are excised for definitive diagnosis. In the era of minimally invasive therapy, some SCP may be followed conservatively. We aim to examine the spectrum of SCP diagnosed on CNB and evaluate if excision of benign/indeterminate SCP is always required. We identified patients with SCP across 3 institutions. The CNB were classified into benign, indeterminate, or malignant. Available excisional specimens were used to classify the lesion as benign or malignant. Clinical variables were reviewed. A total of 197 SCP met the inclusion criteria, including 100 (53%) CNB classified as benign, 52 (26%) indeterminate, and 36 (19%) malignant. Nine patients had excisions without a preceding CNB. Excision was performed in 47% of benign, 87% of indeterminate, and 86% malignant CNB. Of 123 excised SCP, 77 (63%) were benign, while 44 (36%) were malignant. Most benign lesions were not suspicious radiologically (67%), while indeterminate and malignant lesions were more likely to be suspicious (44% and 75%, respectively; P < 0.001). Malignant lesions tended to present as larger, rapidly growing, masses. Most mammary SCP are benign (63% of excisions). Appropriate ancillary tests can safely exclude some malignant entities. We encourage narrowing down the differential diagnosis to pertinent entities based on clinical presentation, imaging, histology, immunohistochemistry, and molecular studies, if applicable. Patients with mammary SCP may be spared surgery provided accurate pathologic diagnosis and appropriate correlation with imaging and clinical data.

show abstract

“…In the clinic, core needle biopsy is an important preoperative technique for PTs diagnosis. However, due to the heterogeneity of masses and the limited tissue taken from biopsy, it is difficult to accurately identify the pathological grade of PTs by using core needle biopsy 7,10 . MRI, with high‐resolution sequences, offers the highest cancer detection rate of all breast imaging modalities 11 .…”

mentioning

confidence: 99%

“…However, due to the heterogeneity of masses and the limited tissue taken from biopsy, it is difficult to accurately identify the pathological grade of PTs by using core needle biopsy. 7,10 MRI, with high-resolution sequences, offers the highest cancer detection rate of all breast imaging modalities. 11 Previous studies have confirmed that MRI is also helpful for distinguishing the pathological types of PTs.…”

mentioning

confidence: 99%

Pretreatment Multiparametric MRI‐Based Radiomics Analysis for the Diagnosis of Breast Phyllodes Tumors

Gong

et al. 2022

Magnetic Resonance Imaging

View full text Add to dashboard Cite

Background: Preoperative pathological grading assessment is important for patients with breast phyllodes tumors (PTs). Purpose: To develop and validate a clinical-radiomics model based on multiparametric MRI and clinical information for the pretreatment differential diagnosis of PTs. Study Type: Retrospective. Population: A total of 216 patients with PTs, 133 in the training cohort (55 benign PTs [BPTs] and 78 borderline/malignant PTs [BMPTs]) and 83 in the validation cohort (28 BPTs and 55 BMPTs).Field Strength/Sequence: 1.5 T and 3 T; T2-weighted imaging (T2WI), precontrast T1-weighted imaging (T1WI) and dynamic contrast-enhanced T1-weighted imaging (DCE-T1WI). Assessment: A total of 3138 radiomics features were computed to decode the imaging phenotypes of PTs. To build the classification models, the following workflow was followed: minimum-maximum scaling normalization method, recursive feature elimination based on ridge regression (Ridge-RFE), synthetic minority oversampling technique, and support vector machine classifier. We established several models based on the statistically significant features (Ridge-RFE selected) of each sequence to distinguish BPTs from BMPTs, including precontrast T1WI model, DCE-T1WI phase 1 model, T1WI feature fusion model, T2WI model, T1WI + T2WI model, clinical feature model, conventional MRI characteristics model, and combined clinical-radiomics model. Statistical Tests: Univariate analysis was utilized to compare variables between the BPT and BMPT groups. The receiver operating characteristic curve (ROC) analysis was used to evaluate the diagnostic performance of these models. Results: In the training cohort, the clinical-radiomics model had excellent diagnostic efficiency, with an area under ROC (AUC) of 0.91 AE 0.02 (95% CI: 0.87-0.94). In the validation cohort, the AUCs were 0.79 AE 0.05 (95% CI: 0.70-0.87) for the combined model and 0.77 AE 0.05 (95% CI: 0.67-0.85) for the radiomics model. Data Conclusion: Compared with conventional MRI characteristics, radiomics features extracted from multiparametric MRI are helpful for improving the accuracy of differentiating the pathological grades of PTs preoperatively. The model based on radiomics and clinical information is expected to become a potential noninvasive tool for the assessment of PTs grades.

show abstract

Accuracy and clinical implications of pre-operative breast core needle biopsy diagnoses of fibroepithelial neoplasms and sarcomatoid carcinomas

Cited by 5 publications

References 35 publications

Low to Intermediate (Borderline) Grade Breast Spindle Cell Lesions on Needle Biopsy: Diagnostic Approach and Clinical Management

Low to Intermediate (Borderline) Grade Breast Spindle Cell Lesions on Needle Biopsy: Diagnostic Approach and Clinical Management

Mammary Spindle Cell Proliferations on Core Needle Biopsy

Pretreatment Multiparametric MRI‐Based Radiomics Analysis for the Diagnosis of Breast Phyllodes Tumors

Contact Info

Product

Resources

About