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

Abdulcadir, D.; Nori, Jacopo; Meattini, Icro; Giannotti, Elisabetta; Boeri, Cecilia; Vanzi, E.; Vezzosi, Vania; Bianchi, Simonetta

doi:10.1016/j.ejso.2014.02.222

Cited by 28 publications

(17 citation statements)

References 21 publications

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“…Both our mean and median ages at presentation were lower than that found in the literature, where median age ranges of 40.0-51.5 years and mean age ranges of 38.6-43.0 years are reported. 3,6,[16][17][18][19] Our association of increasing age with increasing tumour grade is similar to that found in the literature, but again our mean patient age in each group was lower; 31.8 years for benign, 34.4 years for borderline and 36.5 years for malignant tumours than ranges of 39.1-39.5, 41.7-43.2 and 46.8-47.6 years, respectively, in the literature. 3,6,[16][17][18][19] This may be owing to a combination of factors.…”

Section: Discussionsupporting

confidence: 76%

“…On mammography, PT appear as round, well-defined, lobulated, high-density masses, which can have a lucent halo 16,26,27 similar to our findings. They can rarely have coarse calcifications but almost never microcalcification, neither of which was present in our study.…”

Section: Maxwell Et Alsupporting

confidence: 80%

“…They can rarely have coarse calcifications but almost never microcalcification, neither of which was present in our study. 16 Although malignant PTs usually have circumscribed borders, they can have ill-defined or spiculated margins. In our series, of the seven patients with an M4 score or higher, five of the lesions were borderline PTs and two were benign.…”

Section: Maxwell Et Almentioning

confidence: 99%

“…These are lobulations, heterogeneous internal texture, cystic components, horizontal linear clefts, hyperechoic septae, rich vascularization, the absence of microcalcifications and irregular margins. 16,17,19,[26][27][28][29][30] The sonographic appearance of a PT may be related to the grade of the lesion. In one study, most PTs (97%) were well circumscribed and surrounded by a partial or complete capsule or pseudocapsule.…”

Section: Maxwell Et Almentioning

confidence: 99%

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Phyllodes tumours of the breast: radiological presentation, management and follow-up

McCarthy¹,

Kavanagh²,

O'Donoghue³

et al. 2014

The British Journal of Radiology

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Results: 53 patients with 54 lesions were diagnosed as having a PT. The median age was 27.5, 35.0 and 38.5 years for benign, borderline and malignant PT, respectively. Borderline and malignant PTs were larger than benign PTs, with mean sizes of 33 and 42 mm compared with 29 mm. 38% of PTs were labelled by the reporting radiologist as fibroadenomas, including two borderline PTs and one malignant PT. In 24% of cases, the radiologist raised the possibility of PT in the report. 17 patients (40%) developed a new fibroepithelial breast lesion during follow-up of which 4 were recurrent PTs. Conclusion: Despite adequate surgical management, the development of further fibroepithelial lesions in the ipsilateral breast is common. 3-year clinical surveillance, with the addition of 6-monthly ultrasound is advised for females with initial borderline or malignant PT histology. Advances in knowledge:We propose a follow-up protocol with ultrasound based on the grade of the PT diagnosed for 3 years to detect recurrence.Phyllodes tumours (PTs) are rare biphasic fibroepithelial neoplasms accounting for ,1% of all breast lesions. 1 In the literature, they have been described as occurring in females aged 35-55 years, typically 15-20 years older than females with fibroadenomas (FAs) and with a higher incidence in Asian females.2,3 Imaging findings of PT and FA overlap and as such lesions may be misdiagnosed. 4 Histologically, PTs can be identified by their distinctive leaf-like architecture and increased stromal cellularity. 5 Typically, PTs present as a palpable breast lump and were traditionally differentiated from FAs based on their larger size at presentation.6 However, with increased breast awareness and screening programmes, smaller and incidental lesions are being found on imaging. 6 In symptomatic breast clinics, including this institution, "triple assessment" consisting an initial physical examination, followed by radiological imaging (ultrasound and/or mammography) and histological sampling either by fine-needle aspiration cytology (FNAC) or core biopsy is the standard diagnostic pathway for palpable breast lesions. The purpose of triple assessment is to provide a more accurate pre-operative diagnosis to ensure proper surgical planning and avoiding re-excision or tumour recurrence. 7According to the World Health Organization criteria, there are two grading systems for PTs; a two-tiered system or a three-tiered system. 8 Our institution employs the threetiered system, the subgroups being benign, borderline and malignant. Grading is based on semi-quantitative assessment of stromal cellularity, cellular pleomorphism, mitotic activity, margin appearance and stromal distribution. The standard procedure for treatment, no matter what the grade of the PT, is surgical wide local excision, preferably with clear margins of at least 1 cm. However, owing to the fact that most PTs are not fully diagnosed pre-operatively, initial surgery does not always provide adequate margins necessitating frequent post-operative re-excision of the margi...

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Section: Discussionsupporting

confidence: 76%

Section: Maxwell Et Alsupporting

confidence: 80%

Section: Maxwell Et Almentioning

confidence: 99%

Section: Maxwell Et Almentioning

confidence: 99%

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Phyllodes tumours of the breast: radiological presentation, management and follow-up

McCarthy¹,

Kavanagh²,

O'Donoghue³

et al. 2014

The British Journal of Radiology

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“…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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Problematic Core Biopsies

Pinder

2016

Breast Pathology

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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

Cited by 28 publications

References 21 publications

Phyllodes tumours of the breast: radiological presentation, management and follow-up

Phyllodes tumours of the breast: radiological presentation, management and follow-up

Approaches to phyllodes tumour of the breast: a review article

Problematic Core Biopsies

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