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Tariq MU, Rani A, Kayani N, Sattar AK, Vohra L, Idress R. Accuracy and Comparison of Core Needle Biopsy Diagnoses With Excision Specimen for Diagnosing Fibroepithelial Lesions of the Breast. Cureus 2024; 16:e64997. [PMID: 39161474 PMCID: PMC11332694 DOI: 10.7759/cureus.64997] [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] [Accepted: 07/20/2024] [Indexed: 08/21/2024] Open
Abstract
Background Core needle biopsy (CNB) for fibroepithelial lesions (FELs) of the breast is commonly encountered by histopathologists. The distinction between fibroadenoma (FA) and phyllodes tumor (PT) can be challenging due to overlapping histological features and the limited nature of CNB material. Objective This study aimed to assess the accuracy of CNB diagnosis of FA and PT by comparing it with a diagnosis on subsequent surgical excision specimen. Materials and methods A total of 166 cases of FELs of the breast who underwent CNB and subsequent surgical excision between January 2001 and December 2020 were included in our study. All microscopy glass slides were reviewed, and diagnosis confirmed. Results While 125 (75%) cases based on CNB received a definitive diagnosis of either fibroadenoma or PT, the remaining 41 (25%) cases were better classified on excision specimens and were descriptively diagnosed as fibroepithelial lesions on CNB. Diagnoses on CNB and on subsequent excision specimens were concordant in 113 (90.4%) cases. Among 12 cases that were discordant, three cases diagnosed as FA on CNB were upgraded to PT on excision specimens. Nine cases diagnosed as PT on CNB were diagnosed as FA on excision specimens. These included conventional, cellular, juvenile, and complex FA types. Three PTs, which were reported as FA on CNB, measured 6, 12.5, and 17.5 cm in the greatest dimension. Among 23 cases of PT which were further categorized on CNB, tumor categories changed on excision specimens in three cases. The diagnostic accuracy of CNB diagnosis was 90.4%. Conclusion CNB diagnosis showed good accuracy. PT diagnosis should be strongly considered in all tumors measuring >5 cm, especially those exceeding 10 cm. Cellular, juvenile, and complex FAs can be misdiagnosed as PT on CNB. Correlation with clinical and radiological findings can be helpful in establishing correct diagnosis.
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Affiliation(s)
| | - Alka Rani
- Histopathology, Aga Khan University Hospital, Karachi, PAK
| | - Naila Kayani
- Histopathology, Aga Khan University Hospital, Karachi, PAK
| | | | - Lubna Vohra
- Surgery, Aga Khan University Hospital, Karachi, PAK
| | - Romana Idress
- Histopathology, Aga Khan University Hospital, Karachi, PAK
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2
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Elfgen C, Leo C, Kubik-Huch RA, Muenst S, Schmidt N, Quinn C, McNally S, van Diest PJ, Mann RM, Bago-Horvath Z, Bernathova M, Regitnig P, Fuchsjäger M, Schwegler-Guggemos D, Maranta M, Zehbe S, Tausch C, Güth U, Fallenberg EM, Schrading S, Kothari A, Sonnenschein M, Kampmann G, Kulka J, Tille JC, Körner M, Decker T, Lax SF, Daniaux M, Bjelic-Radisic V, Kacerovsky-Strobl S, Condorelli R, Gnant M, Varga Z. Third International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions). Virchows Arch 2023:10.1007/s00428-023-03566-x. [PMID: 37330436 DOI: 10.1007/s00428-023-03566-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/01/2023] [Accepted: 05/17/2023] [Indexed: 06/19/2023]
Abstract
The heterogeneous group of B3 lesions in the breast harbors lesions with different malignant potential and progression risk. As several studies about B3 lesions have been published since the last Consensus in 2018, the 3rd International Consensus Conference discussed the six most relevant B3 lesions (atypical ductal hyperplasia (ADH), flat epithelial atypia (FEA), classical lobular neoplasia (LN), radial scar (RS), papillary lesions (PL) without atypia, and phyllodes tumors (PT)) and made recommendations for diagnostic and therapeutic approaches. Following a presentation of current data of each B3 lesion, the international and interdisciplinary panel of 33 specialists and key opinion leaders voted on the recommendations for further management after core-needle biopsy (CNB) and vacuum-assisted biopsy (VAB). In case of B3 lesion diagnosis on CNB, OE was recommended in ADH and PT, whereas in the other B3 lesions, vacuum-assisted excision was considered an equivalent alternative to OE. In ADH, most panelists (76%) recommended an open excision (OE) after diagnosis on VAB, whereas observation after a complete VAB-removal on imaging was accepted by 34%. In LN, the majority of the panel (90%) preferred observation following complete VAB-removal. Results were similar in RS (82%), PL (100%), and FEA (100%). In benign PT, a slim majority (55%) also recommended an observation after a complete VAB-removal. VAB with subsequent active surveillance can replace an open surgical intervention for most B3 lesions (RS, FEA, PL, PT, and LN). Compared to previous recommendations, there is an increasing trend to a de-escalating strategy in classical LN. Due to the higher risk of upgrade into malignancy, OE remains the preferred approach after the diagnosis of ADH.
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Affiliation(s)
- Constanze Elfgen
- Breast-Center Zurich, Zurich, Switzerland.
- University of Witten-Herdecke, Witten, Germany.
| | - Cornelia Leo
- Breast Center, Kantonsspital Baden, Baden, Switzerland
| | | | - Simone Muenst
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Noemi Schmidt
- Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Cecily Quinn
- Irish National Breast Screening Program & Department of Histopathology, St. Vincent's University Hospital Dublin and School of Medicine, University College Dublin, Dublin, Ireland
| | - Sorcha McNally
- Radiology Department, St. Vincent University Hospital, Dublin, Ireland
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ritse M Mann
- Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Maria Bernathova
- Department of Radiology and Nuclear Medicine, Medical University Vienna, Vienna, Austria
| | - Peter Regitnig
- Diagnostic and Research Institute of Pathology, Medical University Graz, Graz, Austria
| | - Michael Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University Graz, Graz, Austria
| | | | - Martina Maranta
- Department of Gynecology, County Hospital Chur, Chur, Switzerland
| | - Sabine Zehbe
- Radiology Section, Breast Center Stephanshorn, St. Gallen, Switzerland
| | | | - Uwe Güth
- Breast-Center Zurich, Zurich, Switzerland
| | - Eva Maria Fallenberg
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Simone Schrading
- Department of Radiology, County Hospital Lucerne, Lucerne, Switzerland
| | - Ashutosh Kothari
- Breast Surgery Unit, Guy's and St Thomas's NHS Foundation Trust, London, UK
| | | | - Gert Kampmann
- Centro di Radiologia e Senologia Luganese, Lugano, Switzerland
| | - Janina Kulka
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University Budapest, Budapest, Hungary
| | | | | | - Thomas Decker
- Breast Pathology, Reference Centers Mammography Münster, University Hospital Münster, Münster, Germany
| | - Sigurd F Lax
- Department of Pathology, Hospital Graz II, Graz, and School of Medicine, Johannes Kepler University Linz, Linz, Austria
| | - Martin Daniaux
- BrustGesundheitZentrum Tirol, University Hospital Innsbruck, Innsbruck, Austria
| | - Vesna Bjelic-Radisic
- University of Witten-Herdecke, Witten, Germany
- Breast Unit, Helios University Hospital, University Witten/Herdecke, Witten, Germany
| | | | | | - Michael Gnant
- Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria
| | - Zsuzsanna Varga
- Department of Pathology and Molecular Pathology, University Hospital Zürich, Zürich, Switzerland
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Mon KS, Tang P. Fibroepithelial Lesions of the Breast: Update on Molecular Profile With Focus on Pediatric Population. Arch Pathol Lab Med 2023; 147:38-45. [PMID: 35776911 DOI: 10.5858/arpa.2022-0011-ra] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 12/31/2022]
Abstract
CONTEXT.— This review article derives from the breast pathology lecture at the Eighth Princeton Integrated Pathology Symposium (PIPS VIII). OBJECTIVE.— To provide a literature review and update on fibroepithelial lesions of the breast with molecular findings and findings regarding the pediatric population. DATA SOURCES.— The sources include extensive literature review, personal research, and experience. CONCLUSIONS.— Given significant differences in prognosis and management of fibroepithelial lesions, we aim to provide readers with pertinent definitions, pathomorphology, molecular findings, and management for each diagnosis, with insights on the pediatric population.
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Affiliation(s)
- Khin Su Mon
- From the Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Ping Tang
- From the Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
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Latif M, Loya A, Hameed M, Hassan U, Mushtaq S, Hussain M. Diagnosis on Excision Biopsy of Breast Tissues Labeled As Fibroepithelial Tumors on Trucut Samples in a Developing Country. Cureus 2021; 13:e18111. [PMID: 34692322 PMCID: PMC8527186 DOI: 10.7759/cureus.18111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction: Fibroadenomas (FAs) and phyllodes tumors (PTs) are less prevalent but allied to have malignant transformation in many instances. It is a challenge to diagnose the phyllodes by conventional trucut biopsy technique. Objective: To evaluate the histological characteristics of tumors labeled as fibroepithelial lesions of breast tissues on trucut biopsy and compare with a diagnosis on excision biopsy. Methods and materials: It was a descriptive cross-sectional study that was carried out in Shaukat Khanum Memorial Hospital and Research Centre within six years from January 2015 to January 2021. In trucut samples, stromal cellularity, stromal cell nuclear atypia, mitotic count, stromal overgrowth, the enhancement of stromal cellularity adjacent to epithelium were scrutinized. In each category, the activity was seen as absent, mild, moderate, or severe. Mitotic activity was graded as 0-1, 0-5, 5-10, >10. Results: A total of 125 patients were registered for the study. The mean age of patients in our study was 33.86 ± 9.95 years. The mean size was 41.02 ± 27.38 mm with a mean lump duration of 7.52 ± 5.34 months. In the FA group, the trucut sampling report showed the stromal cellularity as mild in 62 (69.7%) and stromal cell nuclear atypia as absent in 68 (76.4%) cases. But in the phyllodes tumor group, the stromal cellularity was severe in 10 (27.8%) patients and stromal cell nuclear atypia was severe in five (13.9%). The ultimate outcome showed that 89 (71.2%) patients had FA and 36 (28.8%) had PT at excision. Conclusion: Assessment of tumor size, stromal cellularity, mitoses, and enhancement of stromal cellularity adjacent to epithelium are useful markers for diagnosing the PT in trucut needle biopsy.
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Affiliation(s)
- Maliha Latif
- Histopathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Asif Loya
- Histopathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Maryam Hameed
- Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Usman Hassan
- Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Sajid Mushtaq
- Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Mudassar Hussain
- Histopathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
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Limberg J, Barker K, Hoda S, Simmons R, Michaels A, Marti JL. Fibroepithelial Lesions (FELs) of the Breast: Is Routine Excision Always Necessary? World J Surg 2021; 44:1552-1558. [PMID: 31974650 DOI: 10.1007/s00268-020-05385-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND When needle core biopsies (NCBs) of the breast reveal fibroepithelial lesions (FELs), excision is often performed to rule out a phyllodes tumor (PT), despite low malignancy rates. Consequently, the natural history of observed FELs is not well described. We analyzed the malignancy risk in excised FELs and the natural history of FELs undergoing active surveillance (AS). METHODS We retrospectively studied the pathology and imaging records of 215 patients with FELs (n = 252) diagnosed on NCB. Incidence of growth was determined by Kaplan-Meier method. RESULTS Of 252 FELs, 80% were immediately excised and 20% underwent AS. Of the excised FELs, 198 (98%) were benign: fibroadenoma (FA) or benign breast tissue in 137 (68%), benign PT in 59 (29%), or LCIS in 2 (1%). Borderline PT or malignant lesions were found in 4 (2%). On ultrasound, malignant and borderline PTs were larger than benign lesions [median 3.9 vs 1.3 cm, p = 0.006]. Fifty FELs underwent AS, with a median follow-up of 17 (range 2-79) months. The majority remained stable or decreased in size: at 2 years, only 35% increased in volume by ≥ 50%. Of those tumors undergoing AS that were later excised (n = 4), all were benign. CONCLUSIONS Almost all FELs (98%) were benign on surgical excision, and the majority undergoing AS remained stable, with benign pathology if later excised. Most FELs on NCB can be safely followed with US, with surgery reserved for patients with FELs that are large, symptomatic, or growing. This could spare most women with FELs unnecessary surgery.
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Affiliation(s)
- Jessica Limberg
- Department of Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 420 East 70th St, Room 251, New York, NY, 10021, USA
| | - Kelly Barker
- Department of Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 420 East 70th St, Room 251, New York, NY, 10021, USA
| | - Syed Hoda
- Department of Pathology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - Rache Simmons
- Department of Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 420 East 70th St, Room 251, New York, NY, 10021, USA
| | - Aya Michaels
- Department of Radiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - Jennifer L Marti
- Department of Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 420 East 70th St, Room 251, New York, NY, 10021, USA.
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Reis YN, Maesaka JY, Shimizu C, Soares-Júnior JM, Baracat EC, Filassi JR. Core needle biopsy in fibroepithelial tumors: predicting factors for phyllodes tumors. Clinics (Sao Paulo) 2021; 76:e2806. [PMID: 33886790 PMCID: PMC8024926 DOI: 10.6061/clinics/2021/e2806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/15/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the clinical and imaging predictive factors for the diagnosis of phyllodes tumors in patients with inconclusive results from core needle biopsy (fibroepithelial lesions). METHODS We retrospectively analyzed data of patients who underwent surgical excision of breast lesions previously diagnosed as fibroepithelial lesions. Numeric variables were analyzed using the Shapiro-Wilk and t-tests, and categorical variables were analyzed using the chi-square and Fisher's exact tests. Multivariate logistic regression was performed to calculate odds ratios and detect predictive factors for the diagnosis of PT. RESULTS A total of 89 biopsy samples were obtained from 77 patients, of which 43 were confirmed as fibroadenomas, 43 as phyllodes tumors, and 3 as other benign, non-fibroepithelial breast lesions. The mean tumor size was 3.61 cm (range, 0.8-10 cm) for phyllodes tumors and 2.4 cm (range, 0.8-7.9 cm) for fibroadenomas. The predictive factor for phyllodes tumor diagnosis was lesion size >3 cm (p<0.001). CONCLUSION Our data indicate that fibroepithelial lesions of the breast larger than 3 cm are more likely to be phyllodes tumors.
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Affiliation(s)
- Yedda Nunes Reis
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Jonathan Yugo Maesaka
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Carlos Shimizu
- Departamento de Radiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - José Maria Soares-Júnior
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Edmund Chada Baracat
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - José Roberto Filassi
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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7
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Phyllodes tumors of the breast: a retrospective analysis of 57 cases. Breast Cancer Res Treat 2020; 181:361-367. [PMID: 32277376 DOI: 10.1007/s10549-020-05620-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 03/26/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Current guidelines for the treatment of phyllodes tumors recommend wide local excision for all histopathological subtypes. However, it is unknown which subtypes have tendency to recur after marginal or incomplete excision. This may lead to over-treatment by re-excision surgery for tumors with little or no potential to recur. MATERIALS AND METHODS All patients with benign, borderline or malignant phyllode tumors presenting at our institution between 2000 and 2016 were retrospectively analyzed. RESULTS A total of 57 patients could be included, of which 39 tumors were benign (60%), three were borderline (5%), and seven were malignant phyllodes tumors (12%). There were also eight phyllodes-like fibroadenomas (14%). Fifty-two patients (91%) underwent local excision as primary treatment, resulting in tumor-positive or close-resection margins in 32 patients (61.5%) of whom five patients (15.6%) had re-excision surgery. During a median follow-up of 5 years, local recurrence occurred in four patients (7.0%) with a median time-to-recurrence of 12 months. Borderline and malignant subtypes were associated with a significantly higher recurrence rate compared to other subtypes (p = 0.039). CONCLUSION Although an adequate tumor-negative resection margin should be obtained for borderline and malignant phyllodes tumors, this study confirms that wide local excision is the appropriate primary treatment for all histopathological subtypes. However, if tumor-negative margins were not obtained at first excision, a wait-and-see approach is justified for benign phyllodes tumors.
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8
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Sim Y, Ng GXP, Ng CCY, Rajasegaran V, Wong SF, Liu W, Guan P, Nagarajan S, Ng WY, Thike AA, Lim JCT, Nasir NDBM, Tan VKM, Madhukumar P, Yong WS, Wong CY, Tan BKT, Ong KW, Teh BT, Tan PH. A novel genomic panel as an adjunctive diagnostic tool for the characterization and profiling of breast Fibroepithelial lesions. BMC Med Genomics 2019; 12:142. [PMID: 31647027 PMCID: PMC6813086 DOI: 10.1186/s12920-019-0588-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 09/23/2019] [Indexed: 02/08/2023] Open
Abstract
Background Known collectively as breast fibroepithelial lesions (FELs), the common fibroadenomas (FAs) and the rarer phyllodes tumors (PTs) are a heterogenous group of biphasic neoplasms. Owing to limited tissue availability, inter-observer variability, overlapping histological features and heterogeneity of these lesions, diagnosing them accurately on core biopsies is challenging. As the choice management option depends on the histological diagnosis; a novel 16-gene panel assay was developed to improve the accuracy of preoperative diagnosis on core biopsy specimens. Methods Using this 16-gene panel, targeted amplicon-based sequencing was performed on 275 formalin-fixed, paraffin-embedded (FFPE) breast FEL specimens, archived at the Singapore General Hospital, from 2008 to 2012. Results In total, 167 FAs, 24 benign, 14 borderline and 6 malignant PTs, were profiled. Compared to FAs, PTs had significantly higher mutation rates in the TERT promoter (p < 0.001), RARA (p < 0.001), FLNA, RB1 and TP53 (p = 0.002, 0.020 and 0.018, respectively). In addition to a higher mutational count (p < 0.001), TERT promoter (p < 0.001), frameshift, nonsense and splice site (p = 0.001, < 0.001 and 0.043, respectively) mutations were also frequently observed in PTs. A multivariate logistic regression model was built using these as variables and a predictive scoring system was developed. It classifies a FEL at low or high risk (score < 1 and ≥ 1, respectively) of being a PT. This scoring system has good discrimination (ROC area = 0.773, 95% CI: 0.70 to 0.85), calibration (p = 0.945) and is significant in predicting PTs (p < 0.001). Conclusion This novel study demonstrates the ability to extract DNA of sufficient quality and quantity for targeted sequencing from FFPE breast core biopsy specimens, along with their successful characterization and profiling using our customized 16-gene panel. Prospective work includes validating the utility of this promising 16-gene panel assay as an adjunctive diagnostic tool in clinical practice.
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Affiliation(s)
- Yirong Sim
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore. .,SingHealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore, Singapore.
| | - Gwendolene Xin Pei Ng
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,Integrated Genomics Platform, National Cancer Centre Singapore, Singapore, Singapore.,Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore, Singapore
| | - Cedric Chuan Young Ng
- Integrated Genomics Platform, National Cancer Centre Singapore, Singapore, Singapore.,Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore, Singapore
| | - Vikneswari Rajasegaran
- Integrated Genomics Platform, National Cancer Centre Singapore, Singapore, Singapore.,Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore, Singapore
| | - Suet Far Wong
- Integrated Genomics Platform, National Cancer Centre Singapore, Singapore, Singapore.,Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore, Singapore
| | - Wei Liu
- Integrated Genomics Platform, National Cancer Centre Singapore, Singapore, Singapore.,Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore, Singapore
| | - Peiyong Guan
- Integrated Biostatistics and Bioinformatics Program, Duke-NUS Medical School, Singapore, Singapore
| | - Sanjanaa Nagarajan
- Integrated Genomics Platform, National Cancer Centre Singapore, Singapore, Singapore.,Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore, Singapore
| | - Wai Yee Ng
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Aye Aye Thike
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Jeffrey Chun Tatt Lim
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | | | - Veronique Kiak Mien Tan
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,SingHealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore, Singapore
| | - Preetha Madhukumar
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,SingHealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore, Singapore
| | - Wei Sean Yong
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,SingHealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore, Singapore
| | - Chow Yin Wong
- SingHealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore, Singapore
| | - Benita Kiat Tee Tan
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,SingHealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore, Singapore
| | - Kong Wee Ong
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,SingHealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore, Singapore
| | - Bin Tean Teh
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Puay Hoon Tan
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore.,Division of Pathology, Singapore General Hospital, Singapore, Singapore
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9
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Neville G, Neill CO, Murphy R, Corrigan M, Redmond PH, Feeley L, Bennett MW, O'Connell F, Browne TJ. Is excision biopsy of fibroadenomas based solely on size criteria warranted? Breast J 2018; 24:981-985. [DOI: 10.1111/tbj.13069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 11/08/2017] [Accepted: 11/08/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Grace Neville
- Department of Pathology; Cork University Hospital Group; Cork Ireland
| | | | - Rosemary Murphy
- Department of Radiology; Cork University Hospital Group; Cork Ireland
| | - Mark Corrigan
- Department of Surgery; Cork University Hospital Group; Cork Ireland
| | - Paul H. Redmond
- Department of Surgery; Cork University Hospital Group; Cork Ireland
| | - Linda Feeley
- Department of Pathology; Cork University Hospital Group; Cork Ireland
| | | | | | - Tara Jane Browne
- Department of Pathology; Cork University Hospital Group; Cork Ireland
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10
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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
Fibroepithelial breast lesions encompass a heterogeneous group of neoplasms that range from benign to malignant, each exhibiting differing degrees of stromal proliferation in relation to the epithelial compartment. Fibroadenomas are common benign neoplasms that may be treated conservatively. Phyllodes tumors are relatively rare lesions, and classified as benign, borderline, or malignant based on histologic evaluation of various parameters. The diagnostic interpretation of "gray-zone" fibroepithelial lesions often imposes formidable demands on a pathologist's skills. This article offers practical recommendations for the diagnostic workup of these lesions, including the appropriate utilization of ancillary investigations and the approach to core needle biopsies.
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East EG, Zhao L, Pang JC, Jorns JM. Characteristics of a Breast Pathology Consultation Practice. Arch Pathol Lab Med 2017; 141:578-584. [PMID: 28353380 DOI: 10.5858/arpa.2016-0371-oa] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - Intradepartmental consultation is a routine practice commonly used for new diagnoses. Expert interinstitutional case review provides insight into particularly challenging cases. OBJECTIVE - To investigate the practice of breast pathology consultation at a large tertiary care center. DESIGN - We reviewed breast pathology cases sent for private consultation and internal cases reviewed by multiple pathologists at a tertiary center. Requisitions and reports were evaluated for diagnostic reason for consultation, rate of multiple pathologist review at the tertiary center, use of immunohistochemistry, and, for private consultation cases, type of sender and concordance with the outside diagnosis. RESULTS - In the 985 private consultation cases, the most frequent reasons for review were borderline atypia (292 of 878; 33.3%), papillary lesion classification (151 of 878; 17.2%), evaluating invasion (123 of 878; 14%), subtyping carcinoma (75 of 878; 8.5%), and spindle cell (67 of 878; 7.6%) and fibroepithelial (65 of 878; 7.4%) lesion classification. Of 4981 consecutive internal cases, 358 (7.2%) were reviewed, most frequently for borderline atypia (90 of 358; 25.1%), subtyping carcinoma (63 of 358; 17.6%), staging/prognostic features (59 of 358; 16.5%), fibroepithelial lesion classification (45 of 358; 12.6%), evaluating invasion (37 of 358; 10.3%), and papillary (20 of 358; 5.6%) and spindle cell (18 of 358; 5.0%) lesion classification. Of all internal cases, those with a final diagnosis of atypia had a significantly higher rate of review (58 of 241; 24.1%) than those with benign (119 of 2933; 4.1%) or carcinoma (182 of 1807; 10.1%) diagnoses. Immunohistochemistry aided in diagnosis of 39.7% (391 of 985) and 21.2% (76 of 359) of consultation and internally reviewed cases, respectively. CONCLUSIONS - This study confirms areas of breast pathology that represent diagnostic challenge and supports that pathologists are appropriately using expert consultation.
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Affiliation(s)
| | | | | | - Julie M Jorns
- From the Departments of Pathology (Drs East, Pang, and Jorns) and Biostatistics (Dr Zhao), University of Michigan, Ann Arbor
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13
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Yeh ED, Frost EP, Raza S, Birdwell RL, Giess CS. Avoiding Pitfalls, Maximizing Success at Image-guided Breast Interventions: A Pictorial Review. Curr Probl Diagn Radiol 2016; 46:161-169. [PMID: 27017404 DOI: 10.1067/j.cpradiol.2016.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 02/16/2016] [Indexed: 11/22/2022]
Abstract
Imaging and image-guided interventions have become increasingly important in the workup and treatment of breast lesions in the past 2 decades. Radiologists should be aware of potential pitfalls during the workup, the procedure itself, and in the postprocedure follow-up. In this pictorial review, we illustrate challenges related to technique and interpretation related to breast interventions, and suggest ways to maximize success.
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Affiliation(s)
- Eren D Yeh
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - Elisabeth P Frost
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sughra Raza
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Robyn L Birdwell
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Catherine S Giess
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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