Development of a Management Algorithm for the Diagnosis of Cellular Fibroepithelial Lesions From Core Needle Biopsies

Jung, Jinkyung; Kang, Eunyoung; Chae, Su Min; Kim, Hyojin; Park, So Yeon; Yun, Bo La; Kim, Sun Mi; Jang, Mijung; Kim, Sung Won; Kim, Eun Kyu

doi:10.1177/1066896918775525

Cited by 11 publications

(9 citation statements)

References 24 publications

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“…Phyllodes tumors, on the other hand, have a propensity of recurrence even after wide excision and in cases of borderline/malignant phyllodes, chemotherapy and radiation might be considered due to the risk of metastasis 18 . Thus, the overlapping features between cellular FA and phyllodes both diagnosed as a “cellular fibroepithelial lesion” on CNB specimens remain a diagnostic and management challenge, and our study of 134 excised lesions could contribute to the limited published data showing an association between clinical‐sonographic findings and surgical excision of such entities 8,12‐15 …”

Section: Discussionmentioning

confidence: 83%

“…Previously published studies demonstrate controversial results. Some of them have shown that the sonographic features were unreliable to differentiate FA and phyllodes tumor due to considerable overlap in findings, 7‐11 and only scant data have demonstrated an association between clinical‐sonographic findings and surgical excision of CFEL 8,12‐15 …”

Section: Introductionmentioning

confidence: 99%

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Cellular fibroepithelial lesions diagnosed on core needle biopsy: Is there any role of clinical‐sonography features helping to differentiate fibroadenomas and phyllodes tumor?

Al-Arnawoot

Scaranelo

Fleming

et al. 2020

Journal of Surgical Oncology

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Objective The purpose of this study is to determine the role of clinico‐sonographic features of breast cellular fibroepithelial lesions (CFELs) diagnosed on core needle biopsy (CNB) in the differentiation between fibroadenoma (FA) and phyllodes. Materials and Methods Results of consecutive women with a CNB showing CFEL from 2005 to 2010 were retrospectively reviewed. Clinical and sonographic findings were compared with surgical outcomes. Chi‐square and Fisher's exact tests were used followed by a regression model for statistical analysis. Results A total of 131 women with 134 CFEL were included in the study; 89 (66%) were FAs and 45 (34%) were phyllodes (32 benign; 13 malignant). Significant predictors of increased risk of phyllodes tumor were patient age equal to or greater than 50 years (P = .021) and lesion size less than 2 cm at sonography (P = .043). No other imaging or clinical features were able to differentiate FA from phyllodes tumors. Conclusion CFEL with a larger size in older women is associated with the surgical pathological result of phyllodes tumor and management should be tailored accordingly. Younger patients with small size nodules might be approached less aggressively, depending on a personalized discussion with the surgeons, taking into account the results obtained in this study.

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Section: Discussionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Cellular fibroepithelial lesions diagnosed on core needle biopsy: Is there any role of clinical‐sonography features helping to differentiate fibroadenomas and phyllodes tumor?

Al-Arnawoot

Scaranelo

Fleming

et al. 2020

Journal of Surgical Oncology

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“…9,10 Both patients were over 40 years old, confirming the findings of Jung et al, who have shown that age !40 years is an independent factor associated with an upgrade of a biopsy diagnosis of fibroadenoma. 11 In accordance with the recent WHO classification of breast tumours, 3 both lesions did not meet the criteria for the diagnosis of either a benign or a malignant fibroepithelial neoplasm. Stromal atypia and mitotic stromal activity were moderately increased and both lesions presented with permeative tumor borders, but stromal overgrowth, marked atypia and malignant heterologous elements were lacking.…”

Section: Discussionmentioning

confidence: 78%

“…9,10 Both patients were over 40 years old, confirming the findings of Jung et al, who have shown that age ≥40 years is an independent factor associated with an upgrade of a biopsy diagnosis of fibroadenoma. 11…”

Section: Discussionmentioning

confidence: 99%

Periductal Stromal Tumors and Phyllodes Tumors Represent a Spectrum of Fibroepithelial Lesions: What Is in a Name?

et al. 2020

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Periductal stromal tumors (PSTs) of the breast are considered as a rare subtype of phyllodes tumors. These rare fibroepithelial lesions display a biphasic morphology, characterized by a cellular stroma surrounding benign ducts. Unlike phyllodes tumors, they do not present with a leaflike architecture, rendering a biopsy diagnosis of a PST very challenging. In this report, we compare the histopathological features of a PST with those of a borderline phyllodes tumor. We discuss the differences and similarities between both entities, and we highlight the potential pitfalls of the respective biopsies. Both cases illustrate that PSTs and phyllodes tumors are part of the same spectrum. This biological spectrum implies that “hybrid” lesions do exist, which can be hard to classify.

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“…A part from clinical evaluation which may be unrevealing, breast ultrasound, mammogram, and biopsy (like core needle biopsy) may be useful un-less surgical removal is done and thus it provides the histological profile (5,6,8). The tumour size varies while more aggressive phenotype are described as hyperplastic, juvenile (between 10 and 18 years), giant (requiring surgery), and phyllodes (which can be malignant and it needs surgery) (1,9).…”

Section: Discussionmentioning

confidence: 99%

Post-menopausal breast fibroadenoma – a point of view

Valea¹,

Şandru²,

Albu³

et al. 2020

Ro Med J.

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Breast fibroadenoma is a benign tumour that is mostly asymptomatic thus it may be detected as an incidentaloma. Typically they are diagnosed in women of reproductive age and they reduce the dimensions during menopause because of estrogens deficiency that is why in menopause are rare. The mass is elastic, mobile and it contains an epithelial part and a stromal component (so called fibroepithelial tumours). Here is the case of a 70-year old female who had done a mammogram for the first time and she was found with such a lesion of 1.5 cm. She also is confirmed with osteopenia, most probable unrelated to the breast tumour. Menopausal fibroadenoma, even at low risk of malignancy requires a good multidisciplinary team of decision. Because of the differential diagnosis with breast cancer the positive diagnostic is based on ultrasound, mammogram and even biopsy. Menopausal fibroadenoma, even at low risk of malignancy requires a good multidisciplinary team of decision. Because of the differential diagnosis with breast cancer the positive diagnostic is based on ultrasound, mammogram and even biopsy. Due to low aggressive profile, the follow-up is, however, the most rational approach.

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Development of a Management Algorithm for the Diagnosis of Cellular Fibroepithelial Lesions From Core Needle Biopsies

Abstract: The scoring system will help clinicians make appropriate treatment for patients with cellular fibroepithelial lesions on core needle biopsy.

Cited by 11 publications

References 24 publications

Cellular fibroepithelial lesions diagnosed on core needle biopsy: Is there any role of clinical‐sonography features helping to differentiate fibroadenomas and phyllodes tumor?

Cellular fibroepithelial lesions diagnosed on core needle biopsy: Is there any role of clinical‐sonography features helping to differentiate fibroadenomas and phyllodes tumor?

Periductal Stromal Tumors and Phyllodes Tumors Represent a Spectrum of Fibroepithelial Lesions: What Is in a Name?

Post-menopausal breast fibroadenoma – a point of view

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