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Gil MLBV, Coelho BA, Couto HL, Silva HMS, Pessoa EC, Sharma N, Mann R, McIntosh SA, Diniz PHC, Cantidio FS, Gil GOB, Salvador AD, de Almeida Júnior WJ, Avelar JTC, Laranjeira CLS, Silva Filho AL. Vacuum-assisted excision: a safe minimally invasive option for benign phyllodes tumor diagnosis and treatment-a systematic review and meta-analysis. Front Oncol 2024; 14:1394116. [PMID: 38807769 PMCID: PMC11130386 DOI: 10.3389/fonc.2024.1394116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 04/16/2024] [Indexed: 05/30/2024] Open
Abstract
Synopsis This is a systematic review and meta-analysis comparing surgical excision with percutaneous ultrasound-guided vacuum-assisted excision (US-VAE) for the treatment of benign phyllodes tumor (PT) using local recurrence (LR) as the endpoint. Objective To determine the frequency of local recurrence (LR) of benign phyllodes tumor (PT) after ultrasound-guided vacuum-assisted excision (US-VAE) compared to the frequency of LR after surgical excision. Method A systematic review and meta-analysis [following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard] was conducted by comparing LR in women older than 18 years treated for benign PT by US-VAE compared with local surgical excision with at least 12 months of follow-up. Studies were retrieved from PubMed, Scopus, Web of Science, and Embase. The pooled effect measure used was the odds ratio (OR) of recurrence. Results Five comparative prospective or retrospective observational studies published between January 1, 1992, and January 10, 2022, comparing surgical excision with percutaneous US-VAE for LR of benign PT met the selection criteria. Four were retrospective observational cohorts, and one was a prospective observational cohort. A total of 778 women were followed up. Of them, 439 (56.4%) underwent local surgical excision, and 339 (43.6%) patients had US-VAE. The median age of patients in the five studies ranged from 33.7 to 39 years; the median size ranged from 1.5 cm to 3.0 cm, and the median follow-up ranged from 12 months to 46.6 months. The needle gauge ranged from 7G to 11G. LR rates were not statically significant between US-VAE and surgical excision (41 of 339 versus 34 of 439; OR 1.3; p = 0.29). Conclusion This meta-analysis suggests that using US-VAE for the removal of benign PT does not increase local regional recurrence and is a safe minimally invasive therapeutic option. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42022309782.
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Affiliation(s)
| | - Bertha Andrade Coelho
- Breast Imaging Department, Brazilian Society of Mastology, Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Obtetrics and Gynecology, UNIFIMOC University Center, Montes Claros, Minas Gerais, Brazil
| | - Henrique Lima Couto
- Breast Imaging Department, Brazilian Society of Mastology, Rio de Janeiro, Rio de Janeiro, Brazil
- Breast Imaging Department, Brazilian Federation of Associations of Gynecologists and Obstetricians, Rio de Janeiro, Rio de Janeiro, Brazil
- Redimama-Redimasto, Belo Horizonte, Minas Gerais, Brazil
| | | | - Eduardo Carvalho Pessoa
- Breast Imaging Department, Brazilian Society of Mastology, Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Obstetrics and Gynecology, Botucatu Medical School, Sao Paulo State University (UNESP), Botucatu, Sao Paulo, Brazil
| | - Nisha Sharma
- Breast Screening Unit, Seacroft Hospital, Leeds Teaching Hospital National Health Service (NHS) Trust, Leeds, United Kingdom
| | - Ritse Mann
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Stuart A. McIntosh
- Patrick G Johnston Centre for Cancer Research, Queen’s University Belfast, Belfast, United Kingdom
| | - Paulo Henrique Costa Diniz
- Oncology Department, Hospital Mater Dei, Belo Horizonte, Minas Gerais, Brazil
- Internal Medicine Department, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | | | - Anna Dias Salvador
- Mastology Department, Rede Mater Dei de Saúde, Belo Horizonte, Minas Gerais, Brazil
| | - Waldeir José de Almeida Júnior
- Mastology Department, Rede Mater Dei de Saúde, Belo Horizonte, Minas Gerais, Brazil
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Cláudia Lourdes Soares Laranjeira
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Obstetrics and Gynecology Department, Rede Mater Dei de Saúde, Belo Horizonte, Minas Gerais, Brazil
| | - Agnaldo Lopes Silva Filho
- Breast Imaging Department, Brazilian Federation of Associations of Gynecologists and Obstetricians, Rio de Janeiro, Rio de Janeiro, Brazil
- Redimama-Redimasto, Belo Horizonte, Minas Gerais, Brazil
- Department of Obstetrics and Gynecology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Horvat JV. High-Risk Lesion Management. Semin Ultrasound CT MR 2023; 44:46-55. [PMID: 36792273 DOI: 10.1053/j.sult.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
High-risk lesions or lesions of uncertain malignant potential are frequent findings on image-guided needle biopsy of the breast and comprise a number of distinct entities. These lesions are known for having risk of underlying malignancy and are usually associated with an increased lifetime risk for breast cancer. Surgical excision was traditionally recommended for all high-risk lesions but recent studies have demonstrated that vacuum-assisted excision or surveillance may be adequate for some lesions. While management of high-risk lesion varies among institutions, this chapter describes the management recommendations based on recent literature of the most frequent types of lesions.
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Affiliation(s)
- Joao V Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
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Mohrmann S, Maier-Bode A, Dietzel F, Reinecke P, Krawczyk N, Kaleta T, Kreimer U, Antoch G, Fehm TN, Roth KS. Malignancy Rate and Malignancy Risk Assessment in Different Lesions of Uncertain Malignant Potential in the Breast (B3 Lesions): An Analysis of 192 Cases from a Single Institution. Breast Care (Basel) 2022; 17:159-165. [PMID: 35702494 PMCID: PMC9149469 DOI: 10.1159/000517109] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 05/02/2021] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND The question of how to deal with B3 lesions is of emerging interest. METHODS In the breast diagnostics of 192 patients between 2009 and 2016, a minimally invasive biopsy revealed a B3 lesion with subsequent resection. This study investigates the malignancy rate of different B3 subgroups and the risk factors that play a role in obtaining a malignant finding. RESULTS The distribution of B3 lesions after minimally invasive biopsy was as follows: atypical ductal hyperplasia (ADH), 7.3%; flat epithelial atypia (FEA), 7.8%; lobular neoplasia (LN), 7.8%; papilloma (Pa), 49.5%; phylloidal tumour (PT), 8.9%; radial sclerosing scar (RS), 3.1%; mixed findings, 10.4%; and other B3 lesions, 5.2%. Most B3 lesions were detected by stereotactic vacuum-assisted biopsy (44.3%), 36.5% by ultrasound-assisted biopsy, and 19.3% by magnetic resonance imaging-assisted biopsy. Most B3 lesions (55.2%) were verified by surgical resection, whereas 30.7% were downgraded to a benign lesion. About 14.1% of the cases were upgraded to malignant lesions, 9.4% to ductal carcinoma in situ and 4.7% to invasive carcinoma. In relation to individual B3 lesions, the following malignancy rates were found: 28.6% (ADH), 13.3% (FEA), 33.3% (LN), 12.6% (Pa), 5.9% (PT), and 0% (RS). The most important risk factor was increasing age. Postmenopausal status was considered an increased risk for an upgrade (p = 0.015). A known malignancy in the ipsilateral breast was a significant risk factor for a malignant upgrade (p = 0.003). CONCLUSION Increasing knowledge about B3 lesions allows us to develop a "lesion-specific" therapy approach in the heterogeneous group of B3 lesions, with follow-up imaging for some lesions with less malignant potential and concordance with imaging or further surgical resection in cases of disconcordance with imaging or higher malignant potential.
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Affiliation(s)
- Svjetlana Mohrmann
- Department of Gynecology and Obstetrics, Medical Faculty, Interdisciplinary Breast Centre, University of Düsseldorf, Düsseldorf, Germany
| | - Anna Maier-Bode
- Department of Gynecology and Obstetrics, Medical Faculty, Interdisciplinary Breast Centre, University of Düsseldorf, Düsseldorf, Germany
| | - Frederic Dietzel
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Petra Reinecke
- Institute of Pathology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Natalia Krawczyk
- Department of Gynecology and Obstetrics, Medical Faculty, Interdisciplinary Breast Centre, University of Düsseldorf, Düsseldorf, Germany
| | - Thomas Kaleta
- Department of Gynecology and Obstetrics, Medical Faculty, Interdisciplinary Breast Centre, University of Düsseldorf, Düsseldorf, Germany
| | - Ulrike Kreimer
- Department of Gynecology and Obstetrics, Medical Faculty, Interdisciplinary Breast Centre, University of Düsseldorf, Düsseldorf, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Tanja N. Fehm
- Department of Gynecology and Obstetrics, Medical Faculty, Interdisciplinary Breast Centre, University of Düsseldorf, Düsseldorf, Germany
| | - Katrin Sabine Roth
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
- ZRN Rheinland, Center for Radiology and Nuclear Medicine, Korschenbroich, Germany
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Wu PS, Lin C, Yang PS, Chang YC, Ko WC, Lam HB. Clinical features, prognostic factors, and treatment outcomes in 611 patients with phyllodes tumors of the breast: The experience of a single institution in Taiwan. JOURNAL OF CANCER RESEARCH AND PRACTICE 2022. [DOI: 10.4103/jcrp.jcrp_27_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Lee A, James J, Whisker L, Rakha EA, Ellis IO. Which lesions with a radiological or core biopsy diagnosis of fibroadenoma should be excised? Ann R Coll Surg Engl 2021; 104:361-366. [PMID: 34939848 DOI: 10.1308/rcsann.2021.0208] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION A recent Association of Breast Surgery summary statement on fibroadenoma management recommends excision only for cellular fibroepithelial lesions and rapidly growing lesions with a core biopsy diagnosis of fibroadenoma; persistent pain is a relative indication for excision. METHODS This retrospective study looked at the impact this approach would have on the diagnosis of phyllodes tumours. RESULTS From 2014 to 2018, there were 1,058 core biopsy diagnoses of fibroadenoma; 112 lesions were excised, of which 98 were fibroadenomas, 4 were hamartomas and 10 were phyllodes tumours. In this group, an excision diagnosis of phyllodes tumour was associated with size more than 40 mm, age more than 40 years and radiological suspicion of phyllodes tumour or carcinoma. One hundred and sixty-six excised fibroepithelial lesions with no previous core biopsy included eight phyllodes tumours; in this group, rapid growth was associated with phyllodes tumour diagnosis. Twelve of the 26 fibroepithelial lesions classified as B3 (cellular fibroepithelial lesion or phyllodes tumour) were diagnosed as phyllodes tumours on excision. Using a combination of radiological, clinical and pathological features it was possible to create an excision policy that would recommend excision of 22 of the 31 phyllodes tumours in this period. Eight of the nine 'missed' phyllodes tumours were benign. CONCLUSION The Association of Breast Surgery summary statement will reduce the number of fibroadenomas excised, but may also result in delayed diagnosis of some phyllodes tumours. Appropriate safety netting advice should be provided to identify rapidly growing lesions.
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Affiliation(s)
- Ahs Lee
- Nottingham University Hospitals NHS Trust, UK
| | - J James
- Breast Institute, Nottingham University Hospitals NHS Trust, UK
| | - L Whisker
- Breast Institute, Nottingham University Hospitals NHS Trust, UK
| | - E A Rakha
- Nottingham University Hospitals NHS Trust, UK
| | - I O Ellis
- Nottingham University Hospitals NHS Trust, UK
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Bogach J, Shakeel S, Wright FC, Hong NJL. Phyllodes Tumors: A Scoping Review of the Literature. Ann Surg Oncol 2021; 29:446-459. [PMID: 34296360 DOI: 10.1245/s10434-021-10468-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/29/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE Phyllodes tumors are rare tumors of the breast, with most literature being retrospective with limited guidelines on the management of these patients. Scoping review was performed to highlight themes and gaps in the available literature. METHODS A scoping review of the literature was performed as per PRISMA-ScR guidelines with titles, abstracts, and full texts reviewed in duplicate. Data were abstracted and summarized in categories of diagnostics, surgical management, adjuvant therapies, treatment of recurrence, and surveillance. Quality assessment was performed for each paper. RESULTS The search identified 4498 references, 434 full-text papers were reviewed, and 183 papers were included. Ultrasound, magnetic resonance imaging, and core needle biopsy are valuable preoperative diagnostics tools. Pathology reporting should include stromal overgrowth, stromal cellularity, nuclear atypia, mitotic rate, borders, and presence of heterologous elements. Ki67 may have a role in grading and prognosticating. Breast conservation is safe in all grades of phyllodes but may be associated with increased local recurrence in malignant phyllodes. Surgical margins should depend on grade. Axillary node positivity rate is very low, even with clinically enlarged lymph nodes. Adjuvant radiation is a useful tool to decrease local recurrence in malignant phyllodes tumors, tumors > 5 cm, age < 45 years, close margins, and breast conservation. There is no evidence supporting adjuvant chemotherapy. Recurrence can be managed with repeat wide excision; however, mastectomy is associated with lower re-recurrence. Surveillance protocols are variable in the literature. CONCLUSIONS There is heterogeneity in the literature on phyllodes tumors. Consensus guidelines based on the literature will help provide evidence-based care.
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Affiliation(s)
- Jessica Bogach
- Department of Surgery, McMaster University, Hamilton, ON, Canada.
| | - Saad Shakeel
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Frances C Wright
- Department of Surgery, University of Toronto, Toronto, ON, Canada.,Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Nicole J Look Hong
- Department of Surgery, University of Toronto, Toronto, ON, Canada.,Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Effectiveness of percutaneous vacuum-assisted excision (VAE) of breast lesions of uncertain malignant potential (B3 lesions) as an alternative to open surgical biopsy. Eur Radiol 2021; 31:9540-9547. [PMID: 34100998 DOI: 10.1007/s00330-021-08060-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/08/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Traditionally B3 breast lesions are treated surgically, but overtreatment is a concern, as the majority have a final benign diagnosis. A national screening program introduced vacuum-assisted excision (VAE) for managing B3 lesions in late 2016. This retrospective study aimed to assess the outcomes associated with this approach. METHODS All B3 lesions diagnosed between 01/2017 and 12/2019 were identified at two centres. Information was obtained on the initial biopsy and final histology, and method of VAE image guidance, needle size and number of cores. Lesions were excluded if there was cancer elsewhere in the breast at the time of diagnosis; the lesion was not suitable for VAE due to position in the breast or had B3 pathology for which open biopsy was still required. The final decision to offer VAE was always made at a multidisciplinary meeting (MDM). Risk difference was used to test the significance at p ≤ .05. RESULTS In total, 258 B3 lesions were diagnosed, 105 (40.7%) met the inclusion criteria and underwent VAE. VAE was performed under X-ray (89/105) or ultrasound guidance (16/105), taking an average of 18.5 cores with the 10-G needle or 10.8 cores with the 7-G needle. Nine cases (8.6%) were upgraded to a malignant diagnosis following VAE. Malignancy was found in 15.5% (9/58) of B3 lesions with epithelial atypia, but in none without atypia (0/47) (p = .004). No new lesions or malignancy has occurred at the site of the VAE with an average mammographic follow-up of 2.2 years. CONCLUSION Upgrade to malignancy following VAE was uncommon (8.6%) and associated with atypia in the initial biopsy. VAE is an alternative approach to the management of B3 lesions, reducing open surgical procedures. KEY POINTS • Upgrade to malignancy after a vacuum-assisted excision of a B3 breast lesion is uncommon with an 8.6% upgrade rate. • The risk of a malignant diagnosis after a vacuum-assisted excision was significantly higher for B3 lesions with atypia compared to those without (+15.5% difference, p = .004).
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Ibreaheem MH, Naguib S, Gamal M, Boutrus R, Gomaa MMM, Talaat O. Phyllodes Tumors of the Breast (the Egyptian Experience). Indian J Surg Oncol 2020; 11:423-432. [PMID: 33013122 PMCID: PMC7501369 DOI: 10.1007/s13193-020-01107-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 05/22/2020] [Indexed: 11/29/2022] Open
Abstract
Phyllodes tumors (PT) are rare fibroepithelial lesions, about 0.3-0.5% of all breast tumors. This study is an evaluation of patient characteristics, clinicopathologic features, diagnostic tools, therapeutic options, risk factors for recurrence, and distant metastasis and follow-up findings in patients with PTs. One hundred twenty-seven patients with pathologically proved PTs in the National Cancer Institute, Cairo University, Egypt, from January 2011 to January 2016 were reviewed and analyzed. Sixty patients presented with benign PTs (47.2%), 34 had borderline PTs (26.8%), and 33 had malignant PTs (26%). The mean follow-up period was approximately 36 months; local recurrence occurred in 34 patients, 9 benign cases (14.5%), 11 borderlines (32.4%), and 14 malignant PTs (42.4%). Mastectomy was the most commonly used surgery in recurrent cases (61.4%). Axillary staging was performed in 31 cases (24.4%); only 2 cases showed positive nodal metastasis (6.5%) and were of the malignant subtype. Distant metastasis occurred in 12 patients, 4 with borderline PTs, and 8 with malignant PTs. The most common site for metastasis was the lungs and bones. Adjuvant radiotherapy was applied in 9 patients, 2 in borderline phyllodes, and 7 in malignant phyllodes; post-radiotherapy recurrence occurred in 5 malignant phyllodes patients. Chemotherapy was employed in 10 metastatic patients (4 with borderline and 6 with malignant phyllodes); excision with clear margins is important to reduce the local recurrence. Routine axillary staging should not be done. The adjuvant radiation therapy is still controversial. Local recurrence can develop even after appropriate surgery. Therefore, close follow-up is mandatory.
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Affiliation(s)
- Maher H. Ibreaheem
- Surgical oncology department, National Cancer Institute, Cairo University Egypt, Giza, Egypt
| | - Sherif Naguib
- Surgical oncology department, National Cancer Institute, Cairo University Egypt, Giza, Egypt
| | - Mohammed Gamal
- Surgical oncology department, National Cancer Institute, Cairo University Egypt, Giza, Egypt
| | - Rimoun Boutrus
- Radiotherapy department, National Cancer Institute, Cairo University, Egypt, Giza, Egypt
| | | | - Omnia Talaat
- Nuclear medicine department, National Cancer Institute, Cairo University, Egypt, Giza, Egypt
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Arora M, Gupta P, Syed A, Aggarwal P, Chowdhury N, Premi V, Mehrotra S, Kapoor A, Pandey D, Sharda P, Ravi B. Mammographic and ultrasonographic concordance in pathologically proven phyllodes tumors: A retrospective study. Breast J 2020; 26:1087-1089. [DOI: 10.1111/tbj.13654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 09/24/2019] [Accepted: 09/24/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Manali Arora
- Integrated Breast Care Centre (IBCC) AIIMS Rishikesh Rishikesh India
| | - Priyanka Gupta
- Integrated Breast Care Centre (IBCC) AIIMS Rishikesh Rishikesh India
| | - Anjum Syed
- Integrated Breast Care Centre (IBCC) AIIMS Rishikesh Rishikesh India
| | - Pradeep Aggarwal
- Department of Community Medicine AIIMS Rishikesh Rishikesh India
| | | | - Vimugdha Premi
- Integrated Breast Care Centre (IBCC) AIIMS Rishikesh Rishikesh India
| | - Surabhi Mehrotra
- Integrated Breast Care Centre (IBCC) AIIMS Rishikesh Rishikesh India
| | - Aakriti Kapoor
- Integrated Breast Care Centre (IBCC) AIIMS Rishikesh Rishikesh India
| | - Divya Pandey
- Integrated Breast Care Centre (IBCC) AIIMS Rishikesh Rishikesh India
| | - Prateek Sharda
- Integrated Breast Care Centre (IBCC) AIIMS Rishikesh Rishikesh India
| | - Bina Ravi
- Integrated Breast Care Centre (IBCC) AIIMS Rishikesh Rishikesh India
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Santucci D, Faiella E, Calabrese A, Favale L, Zobel BB, de Felice C. Our Radiological Experience on B3 Lesions: Correlation Between Mammographic and MRI Findings With Histologic Definitive Result. Clin Breast Cancer 2019; 19:e643-e653. [PMID: 31377083 DOI: 10.1016/j.clbc.2019.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/29/2019] [Accepted: 06/10/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate mammographic and magnetic resonance imaging (MRI) features in B3 lesions. PATIENTS AND METHODS From 2011 to 2018, 139 patients with histologically proven B3 lesions who underwent mammography or/and MRI, were retrospectively reviewed. B3 lesions were classified in: atypical ductal hyperplasia (ADH), lobular neoplasia (LN), papillary lesion (PL), radial scar (RS), flat epithelial atypia (FEA), phyllodes tumor (PT), or mesenchymal lesion. Imaging features evaluated were: the presence of microcalcifications, mass and architectural distortions on mammograms and type of margins (circumscribed, irregular, spiculate), enhancement (mass-like, non-mass-like), size (≤ 15 mm, > 15 mm), and kinetics curves (I, II, III) on MRI. The definitive histologic results confirmed benign lesion or were upgraded to malignancy, and the positive predictive value was calculated. RESULTS Histologic classification of B3 lesions counted 45 (32.37%) ADH, 12 (8.63%) LN, 25 (17.99%) PL, 5 (3.61%) RS, 31 (22.31%) FEA, 20 (14.39%) PT, and 1 (0.70%) mesenchymal lesion. One hundred seven patients had mammography, and 38 had MRI. In 90 (65%) cases, the histologic diagnosis confirmed B3, in 15 (11%) cases, benign lesion, and in 34 (24%) cases, malignancies were found, with best positive predictive value for mesenchymal tumor (1), ADH (0.36), and FEA (0.4). Significant correlations comparing core needle biopsy groups and microcalcifications (P = .016) and presence of mass (P = .002) and comparing definitive histology with the presence of mass (P = .023), were found. Regarding MRI, the morphology correlated with core needle biopsy groups (P = .038); morphology (P = .024), dimension (P = .040), and kinetic curve (P = .005) correlated with malignancy. CONCLUSIONS The B3 category includes different entities, with various risk of malignancy; their heterogeneity is associated with specific mammographic and MRI features, although further confirmations are needed.
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Affiliation(s)
- Domiziana Santucci
- Department of Radiology, University of Rome "Campus Bio-medico", Rome, Italy.
| | - Eliodoro Faiella
- Department of Radiology, University of Rome "Campus Bio-medico", Rome, Italy
| | | | - Luisa Favale
- Department of Radiology, University of Rome "La Sapienza", Rome, Italy
| | | | - Carlo de Felice
- Department of Radiology, University of Rome "La Sapienza", Rome, Italy
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Pinder S, Shaaban A, Deb R, Desai A, Gandhi A, Lee A, Pain S, Wilkinson L, Sharma N. NHS Breast Screening multidisciplinary working group guidelines for the diagnosis and management of breast lesions of uncertain malignant potential on core biopsy (B3 lesions). Clin Radiol 2018; 73:682-692. [DOI: 10.1016/j.crad.2018.04.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 04/11/2018] [Indexed: 10/28/2022]
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Dessauvagie BF, Lee AHS, Meehan K, Nijhawan A, Tan PH, Thomas J, Tie B, Treanor D, Umar S, Hanby AM, Millican-Slater R. Interobserver variation in the diagnosis of fibroepithelial lesions of the breast: a multicentre audit by digital pathology. J Clin Pathol 2018; 71:672-679. [DOI: 10.1136/jclinpath-2017-204977] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 01/23/2018] [Accepted: 01/24/2018] [Indexed: 11/03/2022]
Abstract
AimFibroepithelial lesions (FELs) of the breast span a morphological continuum including lesions where distinction between cellular fibroadenoma (FA) and benign phyllodes tumour (PT) is difficult. The distinction is clinically important with FAs managed conservatively while equivocal lesions and PTs are managed with surgery. We sought to audit core biopsy diagnoses of equivocal FELs by digital pathology and to investigate whether digital point counting is useful in clarifying FEL diagnoses.MethodScanned slide images from cores and subsequent excisions of 69 equivocal FELs were examined in a multicentre audit by eight pathologists to determine the agreement and accuracy of core needle biopsy (CNB) diagnoses and by digital point counting of stromal cellularity and expansion to determine if classification could be improved.ResultsInterobserver variation was high on CNB with a unanimous diagnosis from all pathologists in only eight cases of FA, diagnoses of both FA and PT on the same CNB in 15 and a ‘weak’ mean kappa agreement between pathologists (k=0.36). ‘Moderate’ agreement was observed on CNBs among breast specialists (k=0.44) and on excision samples (k=0.49). Up to 23% of lesions confidently diagnosed as FA on CNB were PT on excision and up to 30% of lesions confidently diagnosed as PT on CNB were FA on excision. Digital point counting did not aid in the classification of FELs.ConclusionAccurate and reproducible diagnosis of equivocal FELs is difficult, particularly on CNB, resulting in poor interobserver agreement and suboptimal accuracy. Given the diagnostic difficulty, and surgical implications, equivocal FELs should be reported in consultation with experienced breast pathologists as a small number of benign FAs can be selected out from equivocal lesions.
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Abstract
RATIONALE Phyllodes tumors (PT) of the breast are rare neoplasm originating from fibroepithelial component. To our knowledge, our report is the first reported case of PT in 2 sisters. PATIENT CONCERNS We presented 2 cases of PT of the breast involving in 2 sisters. On physical examination of the younger sister, a firm mass measuring approximately 3 cm in diameter was identified in upper inner quadrant of the right breast. Physical examination of the elder sister revealed a 3 cm lump in upper outer quadrant of the left breast. DIAGNOSES Histopathology of the younger sister revealed a malignant PT. The elder sister was diagnosed with borderline PT. INTERVENTIONS The younger sister with malignant PT underwent right mastectomy. The elder sister with borderline PT was scheduled for wide resection of the mass in the left breast. OUTCOMES After a follow-up of 23 months, no local or distant recurrence was observed. LESSONS Our cases indicate that genetic factor may contribute to the risk of PT of the breast. Markers such as p53 and Ki-67 may have some correlation with PT malignancy.
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Affiliation(s)
| | | | | | | | - Xiaoqin Yang
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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Marcil G, Wong S, Trabulsi N, Allard-Coutu A, Parsyan A, Omeroglu A, Atinel G, Mesurolle B, Meterissian S. Fibroepithelial breast lesions diagnosed by core needle biopsy demonstrate a moderate rate of upstaging to phyllodes tumors. Am J Surg 2017; 214:318-322. [DOI: 10.1016/j.amjsurg.2016.12.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 12/08/2016] [Accepted: 12/26/2016] [Indexed: 11/28/2022]
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Tremblay-LeMay R, Hogue JC, Provencher L, Poirier B, Poirier É, Laberge S, Diorio C, Desbiens C. How Wide Should Margins Be for Phyllodes Tumors of the Breast? Breast J 2016; 23:315-322. [DOI: 10.1111/tbj.12727] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Rosemarie Tremblay-LeMay
- Département de biologie moléculaire, biochimie médicale et pathologie; Université Laval; Quebec City Quebec Canada
| | - Jean-Charles Hogue
- Centre de Recherche sur le Cancer; Université Laval; Quebec City Quebec Canada
- Axe oncologie; Centre de recherche du CHU de Québec - Université Laval; Quebec City Quebec Canada
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec - Université Laval; Quebec City Quebec Canada
| | - Louise Provencher
- Centre de Recherche sur le Cancer; Université Laval; Quebec City Quebec Canada
- Axe oncologie; Centre de recherche du CHU de Québec - Université Laval; Quebec City Quebec Canada
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec - Université Laval; Quebec City Quebec Canada
- Département de chirurgie; Université Laval; Quebec City Quebec Canada
| | - Brigitte Poirier
- Centre de Recherche sur le Cancer; Université Laval; Quebec City Quebec Canada
- Axe oncologie; Centre de recherche du CHU de Québec - Université Laval; Quebec City Quebec Canada
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec - Université Laval; Quebec City Quebec Canada
- Département de chirurgie; Université Laval; Quebec City Quebec Canada
| | - Éric Poirier
- Centre de Recherche sur le Cancer; Université Laval; Quebec City Quebec Canada
- Axe oncologie; Centre de recherche du CHU de Québec - Université Laval; Quebec City Quebec Canada
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec - Université Laval; Quebec City Quebec Canada
- Département de chirurgie; Université Laval; Quebec City Quebec Canada
| | - Sophie Laberge
- Centre de Recherche sur le Cancer; Université Laval; Quebec City Quebec Canada
- Axe oncologie; Centre de recherche du CHU de Québec - Université Laval; Quebec City Quebec Canada
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec - Université Laval; Quebec City Quebec Canada
- Département de médecine sociale et préventive; Université Laval; Quebec City Quebec Canada
- Service de Pathologie; Hôpital du Saint-Sacrement; CHU de Québec - Université Laval; Quebec City Quebec Canada
| | - Caroline Diorio
- Centre de Recherche sur le Cancer; Université Laval; Quebec City Quebec Canada
- Axe oncologie; Centre de recherche du CHU de Québec - Université Laval; Quebec City Quebec Canada
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec - Université Laval; Quebec City Quebec Canada
- Département de médecine sociale et préventive; Université Laval; Quebec City Quebec Canada
| | - Christine Desbiens
- Centre de Recherche sur le Cancer; Université Laval; Quebec City Quebec Canada
- Axe oncologie; Centre de recherche du CHU de Québec - Université Laval; Quebec City Quebec Canada
- Centre des Maladies du Sein Deschênes-Fabia; Hôpital du Saint-Sacrement; CHU de Québec - Université Laval; Quebec City Quebec Canada
- Département de chirurgie; Université Laval; Quebec City Quebec Canada
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Abstract
Background Here, the treatment methods and results of patients with phyllodes tumor of the breast (PT) with distant metastases at a single institution are presented. Methods A retrospective analysis was performed on a group of 295 patients with PT treated from 1952 to 2010. Results Distant metastases developed in 37 (12.5 %) patients; 3/160 (1.9 %) patients had benign PT, 6/36 (16.7 %) were considered borderline, and 28/99 (28.3 %) had malignant PT. Most frequently, the metastases were located in the lungs; 28 (75.7 %), bone 7 (18.9 %), brain 4 (10.8 %), and liver 2 (5.4 %). Metastases occurred on overage 21 months (2–57) after surgery. Patients with lung metastases were generally treated with monochemotherapy or polychemotherapy. In one patient Testosterone and in two patients resection of metastases combined with Doxorubicin were used. Patients with bones or brain metastases were treated with palliative radiotherapy only or combined with Doxorubicin. The mean survival (MS) from diagnosis of distant metastases (DM) was 7 months (2–17). The longest mean survival in patients with bones metastases was 11.8 months, the worst survival was for patients with brain metastases—2.8 months. Hormone therapy appeared to have low efficacy (MS: 2 months) as well as monochemotherapy (MS: 3–5 months). Improved MS was obtained using Doxorubicin (7 months) and Doxorubicin with Cisplatin, Cyclophosphamide, or Ifosfamide (9 months). Conclusion The prognosis of patients with DM from PT is poor. The role of surgery and irradiation of such patients is very limited. There appears to be no role for the use of hormone therapy. This study showed that polychemotherapy with Doxorubicin and Ifosfamide suggest that it might be more effective than once thought.
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Bendifallah S, Canlorbe G. [Common benign breast tumors including fibroadenoma, phyllodes tumors, and papillary lesions: Guidelines]. ACTA ACUST UNITED AC 2015; 44:1017-29. [PMID: 26547891 DOI: 10.1016/j.jgyn.2015.09.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 09/18/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To provide guidelines for clinical practice from the French College of Obstetrics and Gynecology (CNGOF), based on the best evidence available, concerning common benign breast tumors: fibroadenoma (FA), phyllodes breast tumors (PBT), and papillary lesions (BPL). METHODS Bibliographical search in French and English languages by consultation of PubMed, Cochrane and international databases. RESULTS In case of percutaneous biopsy diagnosis of FA, clinico-radiologic and pathologic discordance or complex FA or proliferative lesions or atypia with FA, a family history of cancer, it seems legitimate to discuss management in a multidisciplinary meeting. When surgery is proposed for FA, periareolar compared to direct incision is associated with more insensitive nipple but better aesthetic results (LE4). When surgery is proposed for FA, indirect incision is preferable for better cosmetic results (Grade C). Techniques of percutaneous destruction or resection can be used (Grade C). The WHO classification distinguishes three categories of phyllodes tumors (PBT): benign (grade 1), borderline (grade 2) and malignant (grade 3). For grade 1 PBT, the risk of local recurrence after surgical excision increases when PBT lesion is in contact with surgical limits (not in sano). After in sano resection, there is no correlation between margin size and the risk of recurrence (LE4). For grade 2 PBT, local recurrence after surgical excision increases for margins under 10mm margins (LE4). For grade 1-2 PBT, in sano excision is recommended. For grade 2 PBT, 10-mm margins are recommended (Grade C). No lymph node evaluation or neither systematic mastectomy is recommended (Grade C). Breast papillary lesion (BPL) without atypia, complete resection of radiologic signal is recommended (Grade C). For BPL with atypia, complete excisional surgery is recommended (Grade C).
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Affiliation(s)
- S Bendifallah
- Service de gynécologie-obstétrique, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Institut universitaire de cancérologie, université Pierre-et-Marie-Curie, Paris-6, 75005 Paris, France; UMRS 1136, institut Pierre-Louis et de santé publique (IPLESP), 56, boulevard Vincent-Auriol, 75646 Paris cedex 13, France.
| | - G Canlorbe
- Service de gynécologie-obstétrique, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Institut universitaire de cancérologie, université Pierre-et-Marie-Curie, Paris-6, 75005 Paris, France; UMRS 938, université Pierre-et-Marie-Curie, site Saint-Antoine, 27, rue Chaligny, 75012 Paris, France
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McCarthy E, Kavanagh J, O'Donoghue Y, McCormack E, D'Arcy C, O'Keeffe SA. Phyllodes tumours of the breast: radiological presentation, management and follow-up. Br J Radiol 2014; 87:20140239. [PMID: 25270608 DOI: 10.1259/bjr.20140239] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Phyllodes tumours (PTs) are rare neoplasms accounting for <1% of breast lesions. With increased breast awareness and screening programmes, smaller PTs are being detected. The purpose of this study was to determine the clinical, radiological and pathological presentation of PTs and to evaluate the role of imaging follow-up, for which there are no specific guidelines. METHODS A retrospective study of all patients diagnosed with PT in a symptomatic unit between January 2006 and March 2013 was carried out. Patients were identified using breast care and electronic patient record databases. 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.
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Affiliation(s)
- E McCarthy
- 1 Department of Radiology, St James's Hospital and Trinity College Dublin, Dublin, Ireland
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