The sensitivity of needle core biopsy in combination with other investigations for the diagnosis of phyllodes tumours of the breast

Ward, Steve; Jewkes, A.; Jones, B.; Chaudhri, S.; Hejmadi, Rahul; Ismail, Tariq; Hallissey, M. T.

doi:10.1016/j.ijsu.2012.08.002

Cited by 34 publications

(32 citation statements)

References 23 publications

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“…It is established that larger PTs are in general more likely to be of a higher grade, and all lesions in our institution measuring .30 mm are excised. 20,21 However, size criteria alone are not sufficient to distinguish FA from PT, indeed the mean size of our 34 benign PTs was 29 mm and 9 lesions were ,30 mm in the under-25-year age group. FNAC sensitivity of 50% and core biopsy sensitivity of 80% lie within the quoted ranges of 25-70% and 44-92%, respectively.…”

Section: Maxwell Et Almentioning

confidence: 83%

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: Maxwell Et Almentioning

confidence: 83%

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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“…However, the available literature reveals that although CNB showed greater accuracy than other methods such as ultrasound, mammogram, and MRI in diagnosing PTB (17,18), it still has limited clinical significance (12,(19)(20)(21). Consistent with CNB, core needle biopsy; PTB, phyllodes tumors of the breast.…”

Section: Discussionmentioning

confidence: 99%

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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“…During fine-needle or tru-cut biopsy of phyllodes tumors, if the sampling consists of benign cells it can be diagnosed as fibroadenoma, or if malignant stromal cells were sampled a diagnosis of sarcoma is likely. For the diagnosis of phyllodes tumor, the sensitivity of fine-needle biopsy ranges between 23-40%, and the sensitivity of tru-cut biopsy ranges from 63-65% (8,9). The lesions of study patients were radiologically benign and they were excised due to their large size.…”

Section: Discussionmentioning

confidence: 99%

Analysis of patients with phylloides tumor of the breast

Atalay

Kınaş

Çelebioğlu

2014

UCD

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The sensitivity of needle core biopsy in combination with other investigations for the diagnosis of phyllodes tumours of the breast

Cited by 34 publications

References 23 publications

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

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

Diagnostic performance of core needle biopsy in identifying breast phyllodes tumors

Analysis of patients with phylloides tumor of the breast

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