Core Needle Biopsy as a Diagnostic Tool to Differentiate Phyllodes Tumor From Fibroadenoma

Komenaka, Ian K.; El‐Tamer, Mahmoud; Pile-Spellman, Eliza; Hibshoosh, Hanina

doi:10.1001/archsurg.138.9.987

Cited by 115 publications

(90 citation statements)

References 10 publications

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“…Choi (12) reported that among 129 patients having undergone preoperative CNB diagnosis, 104 were verified by postoperative pathology, yielding an accuracy rate of 80.6%, similar to the results of Bode et al (11). In addition, Komenaka et al (22) and Ward et al (17) reported accurate CNB diagnostic rates of 76.0% and 63.0%. Although these four reports achieved diagnosis rates above 50%, most studies reported accuracies below this line (15,19,20,(23)(24)(25).…”

Section: Discussionmentioning

confidence: 53%

Diagnostic performance of core needle biopsy in identifying breast phyllodes tumors

Zhou¹,

Wang²,

Sun³

et al. 2016

J. Thorac. Dis.

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Background: A retrospective analysis of diagnoses was performed in patients with phyllodes tumors of the breast (PTB) who received preoperative core needle biopsy (CNB) and had breast surgery at Fudan University Shanghai Cancer Center from January 1, 2002 to April 1, 2013. The resulting data allowed us to compare the accordance between CNB and excision diagnoses of PTB patients and evaluate the accuracy of CNB in preoperative diagnosis. Methods:Data from 128 patients with PTB who had undergone preoperative CNB and breast surgery were retrospectively analyzed. We reviewed the medical history, clinical follow-up data, and CNB diagnostic data. A diagnostic test was used to evaluate the sensitivity and specificity of CNB in diagnosing benign, borderline, and malignant phyllodes tumors.Results: The accuracy of CNB for diagnosing PTB was 13.3% (17/128). Of the remaining patients, 98(75.5% of the PTB patients) were diagnosed with fibroadenoma or fibroepithelial lesions. The sensitivity of CNB at diagnosing benign, borderline, and malignant phyllodes tumors were 4.9% (2/41), 4.2% (3/71), and 25.0% (4/16), respectively, whereas the corresponding specificity were 92.0%, 98.2%, and 100%, respectively. Some clinical features, such as large tumor size, rapid growth, or surgical history of fibroadenomas, were indicative of an increased possibility of PTB.Conclusions: CNB provides a pathological basis for the preoperative diagnosis of PTB, but it has a poor accuracy and offers limited guidance for surgical decisions. Considering CNB along with multiple histologic features may improve the ability to accurately diagnose PTB. An integrated assessment using CNBs in combination with clinical data and imaging features is suggested as a reliable strategy to assist PTB diagnosis.

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Section: Discussionmentioning

confidence: 53%

Diagnostic performance of core needle biopsy in identifying breast phyllodes tumors

Zhou¹,

Wang²,

Sun³

et al. 2016

J. Thorac. Dis.

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“…Core biopsy represents the best modality for preoperative diagnosis with a sensitivity of 99%, negative predictive value and positive predictive value 93% and 83%, respectively. 24 Core biopsy using 14-gauge needle enables to provide an extra-architectural information provided by histology compared with cytology. 25 In the case of ulcerated lesion, wedge biopsy is needed instead.…”

Section: Diagnosismentioning

confidence: 99%

Approaches to phyllodes tumour of the breast: a review article

et al. 2017

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Phyllodes tumours are rare entities of fibroepithelial diseases. The exact pathogenesis and their relationship with fibroadenomas are oblivious. Women aged between 35 to 55 years are commonly affected, even younger in Asian population. Triple assessment should be applied as a guide to management in any breast pathology. Clinical appearances are typically diagnostic for phyllodes tumours. Even though sometimes inconclusive, mammography and ultrasonography are the main imaging modalities. Although the role of cytology is debatable, presence of both epithelial and stromal elements supports the diagnosis especially in malignant type. Core biopsy is rather favored in view of higher accuracy for the diagnosis. Accurate preoperative assessment and histologic diagnosis allow correct surgical intervention and subsequent avoidance of reoperation. Surgical management can be either wide excision with more than 1 cm margins or mastectomy without axillary surgery. Local recurrence has been associated with inadequate excision of the pseudopod. Adjuvant radiotherapy is recommended for positive surgical margin and for local control of borderline and malignant phyllodes tumors. The role of chemotherapy and endocrine therapy has not been fully studied.

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“…Although CNB can provide high negative and positive predictive values, accurate diagnosis based on a limited sample from CNBs can sometimes be challenging for fibroepithelial neoplasms because of the heterogeneity and overlapping features in these lesions. 9,10,26 At times, fibroadenoma can show moderate cellularity, mimicking PTs, and PTs may have heterogeneous components similar to benign fibroadenoma. Many studies have shown the need for biomarkers, especially Ki-67, in addition to the histologic features of these lesions for more accurate preoperative evaluation.…”

Section: Role Of Core Needle Biopsy In Diagnosis Of Fibroepithelial Tmentioning

confidence: 99%

Fibroepithelial Tumors of the Breast: Pathologic and Immunohistochemical Features and Molecular Mechanisms

Yang

Kandil

Cosar

et al. 2014

Archives of Pathology &Amp; Laboratory Medicine

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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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Core Needle Biopsy as a Diagnostic Tool to Differentiate Phyllodes Tumor From Fibroadenoma

Cited by 115 publications

References 10 publications

Diagnostic performance of core needle biopsy in identifying breast phyllodes tumors

Diagnostic performance of core needle biopsy in identifying breast phyllodes tumors

Approaches to phyllodes tumour of the breast: a review article

Fibroepithelial Tumors of the Breast: Pathologic and Immunohistochemical Features and Molecular Mechanisms

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