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Bennett DL, Buckley A, Lee MV. Fibrocystic Change. Radiol Clin North Am 2024; 62:581-592. [PMID: 38777535 DOI: 10.1016/j.rcl.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Fibrocystic changes are commonly seen in clinically symptomatic patients and during imaging workup of screening-detected findings. The term "fibrocystic changes" encompasses a broad spectrum of specific benign pathologic entities. Recognition of classically benign findings of fibrocystic changes, including cysts and layering calcifications, can prevent unnecessary follow-ups and biopsies. Imaging findings such as solid masses, nonlayering calcifications, and architectural distortion may require core needle biopsy for diagnosis. In these cases, understanding the varied appearances of fibrocystic change aids determination of radiologic-pathologic concordance. Management of fibrocystic change is typically conservative.
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Affiliation(s)
- Debbie L Bennett
- Department of Breast Imaging, Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, 510 South Kingshighway Boulevard, Box 8131, St Louis, MO, USA.
| | - Arianna Buckley
- Department of Breast Imaging, Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, 510 South Kingshighway Boulevard, Box 8131, St Louis, MO, USA
| | - Michelle V Lee
- Department of Breast Imaging, Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, 510 South Kingshighway Boulevard, Box 8131, St Louis, MO, USA
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2
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Yuan M, Saeki H, Horimoto Y, Ishizuka Y, Onagi H, Saito M, Hayashi T, Arakawa A, Yao T. Stromal Ki67 Expression Might be a Useful Marker for Distinguishing Fibroadenoma From Benign Phyllodes Tumor of the Breast. Int J Surg Pathol 2024; 32:223-229. [PMID: 37157807 DOI: 10.1177/10668969231171132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Background. Fibroadenoma (FA) and benign phyllodes tumor (PT) of the breast often have similar appearances on imaging. While an exact diagnosis of biopsy specimens is required to choose adequate treatment, including surgical procedures, it is sometimes difficult to pathologically differentiate these 2 tumors due to histological resemblances. To elucidate markers for distinguishing FA from benign PT, we analyzed clinical samples immunohistochemically. Methods. We retrospectively investigated 80 breast fibroepithelial lesions. As a discovery set, 60 surgical excision samples (30 FA and 30 benign PT) were examined. Twenty biopsy samples (10 FA and 10 benign PT) were examined as a validation set. To determine targets for immunohistochemistry, we first tested some proteins based on previous reports. As a result, Ki67 was chosen for differentiating FA and PT; thus further examinations were conducted with this protein. Results. Among the proteins examined, stromal Ki67 was significantly higher in PT than in FA. Benign PT had significantly higher stromal Ki67 expression both at random and at hotspots (p < .001 and <.001, respectively). The receiver operating characteristic curve analysis identified 3.5% and 8.5% (at random spots and hotspots, respectively) as the optimal cutoff values of stromal Ki67 for distinguishing between these 2 tumors. In the validation cohort employing needle biopsy specimens, we confirmed that these 2 cutoff values properly classified these 2 tumors (p = .043 and .029, respectively). Conclusion.We revealed that stromal Ki67 might be a potential marker for distinguishing FA from benign PT.
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Affiliation(s)
- Men Yuan
- Juntendo University School of Medicine, Tokyo, Japan
| | - Harumi Saeki
- Juntendo University School of Medicine, Tokyo, Japan
| | | | | | - Hiroko Onagi
- Juntendo University School of Medicine, Tokyo, Japan
| | - Mitsue Saito
- Juntendo University School of Medicine, Tokyo, Japan
| | - Takuo Hayashi
- Juntendo University School of Medicine, Tokyo, Japan
| | | | - Takashi Yao
- Juntendo University School of Medicine, Tokyo, Japan
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3
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Faulds TT, Bruckner J, Mousa M, Bhanu S, Chin M, Cendrowski K. Giant phyllodes tumor of the breast: A case report. Radiol Case Rep 2024; 19:818-824. [PMID: 38111558 PMCID: PMC10726342 DOI: 10.1016/j.radcr.2023.11.019] [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] [Received: 09/15/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 12/20/2023] Open
Abstract
Phyllodes tumors of the breast are rare fibroepithelial neoplasms that account for less than 1% of all breast tumors. They tend to affect middle-aged women, who present with a rapidly growing, palpable mass. Here we present a case of a 34-year-old female surrogate mother without any reported personal or family history of breast cancer who presented with a rapidly growing left breast mass, pathologically proven to be a phyllodes tumor. The patient was a G7P7 surrogate mother who received estrogen and progesterone injections for her twin surrogate pregnancy starting 4 months before embryo implantation, after which, she discovered a large palpable mass in the left breast at approximately week 7 gestational age. At the initial presentation, the patient was at week 23 gestational age. She underwent C-section delivery of the twins at this time and obtained further work-up of the mass. She had a core needle biopsy which yielded a benign fibroepithelial tumor. Due to the size of her breast mass and atypical morphology, including extension to the nipple, and skin ulceration, the patient subsequently underwent left mastectomy. At the time of mastectomy, which was 8 months after the initial work-up, the mass had grown to measure approximately 12 × 10 cm on physical examination and took up most of her left breast. It was completely resected and was pathologically determined to be a borderline phyllodes tumor. Only a few cases have been reported about the development of phyllodes tumor during pregnancy in the literature, and we believe this is the first case report of phyllodes tumor related to a surrogate pregnancy. Although the relationship between exogenous hormones and fibroepithelial tumors is not well understood, the case poses the clinical question if screening mammograms should be offered to patients undergoing exogenous hormonal therapy, regardless of age to establish a baseline and monitor for the development (if any) or growth of these tumors.
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Affiliation(s)
- Tam Truong Faulds
- Riverside Community Hospital, Riverside, CA, USA
- HCA Healthcare, Nashville, TN, USA
| | - Jacob Bruckner
- Riverside Community Hospital, Riverside, CA, USA
- HCA Healthcare, Nashville, TN, USA
| | - Michael Mousa
- Riverside Community Hospital, Riverside, CA, USA
- HCA Healthcare, Nashville, TN, USA
| | - Shiv Bhanu
- Riverside Community Hospital, Riverside, CA, USA
- HCA Healthcare, Nashville, TN, USA
| | - Michael Chin
- Riverside Community Hospital, Riverside, CA, USA
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4
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Huang Y, Yao G, Wan Y. Clinical and radiological evaluation of a phyllodes tumor of the breast: a case report. Anticancer Drugs 2024; 35:203-208. [PMID: 38085253 DOI: 10.1097/cad.0000000000001548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Phyllodes tumors (PTs) are rare breast tumors characterized by varying biological behavior and heterogeneous clinical findings. As a result, accurately diagnosing PTs preoperatively is challenging, often leading to misdiagnosis. A 49-year-old patient presented with a steadily growing right breast mass that had persisted over a 10-year period. Breast mammography and ultrasonography results indicated the presence of a PT. Following a lumpectomy, the patient was diagnosed with a borderline PT. However, nearly 1 year later, she was readmitted due to the recurrence of a palpable mass at the site. Consequently, 1 year and 8 months after the initial operation, she underwent thoracoscopic lobectomy to address solitary lung metastases. Subsequently, the patient experienced brain metastasis and massive hemorrhage 14 months later. Long-term follow-up was recommended. This case study presents an instance of borderline PT with clinical and imaging features that are crucial for guiding clinical operations and evaluating patient prognosis.
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Affiliation(s)
- Yan Huang
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine & Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong Province, China
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5
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Ramala SR, Chandak S, Chandak MS, Annareddy S. A Comprehensive Review of Breast Fibroadenoma: Correlating Clinical and Pathological Findings. Cureus 2023; 15:e49948. [PMID: 38179396 PMCID: PMC10765224 DOI: 10.7759/cureus.49948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/05/2023] [Indexed: 01/06/2024] Open
Abstract
Breast fibroadenomas, common benign conditions, exhibit distinct clinical and histopathological features. This review highlights clinical presentation and histology correlations, providing insights for healthcare providers. Palpable masses, pain, and changes in breast appearance align with glandular and stromal components, emphasizing accurate diagnosis. Mammography, ultrasound, and MRI guide tailored treatment decisions. Challenges in differentiating atypical fibroadenomas highlight the need for meticulous histopathological evaluation. Clinical implications stress patient-centered care, shared decision-making, and ongoing follow-up. Future research focuses on genetic investigations and long-term studies. A multidisciplinary approach to breast fibroadenomas ensures comprehensive care for improved outcomes in both medical and emotional aspects.
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Affiliation(s)
- Sandeep Reddy Ramala
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Suresh Chandak
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Meenakshi S Chandak
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Srinivasulareddy Annareddy
- Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Goodwin B, Oyinlola AF, Palhang M, Lehman D, Platoff R, Atabek U, Spitz F, Hong Y. Metastatic and Malignant Phyllodes Tumors of the Breast: An Update for Current Management. Am Surg 2023; 89:6190-6196. [PMID: 37611540 DOI: 10.1177/00031348231198114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
Metastatic, malignant phyllodes tumor (PT) of the breast is a rare and aggressive neoplasm. Currently, there is no agreed upon consensus as to best management practices. A systematic review of literature was conducted investigating surgical, chemotherapeutic, and radiotherapeutic management for metastatic PT. Databases employed to identify articles included Embase, PubMed, and SAGE Journals. Diagnosis of metastatic PT has been of significant difficulty to radiologists as it is often confused with fibroadenomas. Surgically, metastatectomy has been correlated with increased overall survival (of 25.9 versus 9.9 months; P = .01). Radiotherapy has often been associated with palliation and pain control in metastatic, malignant neoplasia. However, one study showed that in malignant PT, radiation was associated with significantly lower rates of local recurrence (OR: 0.048 versus 0.209). Anthracycline containing chemotherapy regimens has been associated with improved overall survival (22.4 months versus 13.2 months; P = .040). Further research must be conducted into this rare malignancy to elucidate accurate diagnosis and care for patients with advanced metastatic or malignant phyllodes tumors.
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Affiliation(s)
- Brandon Goodwin
- Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | | | - Meejan Palhang
- Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Danielle Lehman
- Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | | | - Umur Atabek
- Department of Surgery, Cooper University Hospital, Camden, NJ, USA
| | - Francis Spitz
- Department of Surgery, Cooper University Hospital, Camden, NJ, USA
| | - Young Hong
- Department of Surgery, Cooper University Hospital, Camden, NJ, USA
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7
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Zhang M, Arjmandi FK, Porembka JH, Seiler SJ, Goudreau SH, Merchant K, Hwang H, Hayes JC. Imaging and Management of Fibroepithelial Lesions of the Breast: Radiologic-Pathologic Correlation. Radiographics 2023; 43:e230051. [PMID: 37856317 DOI: 10.1148/rg.230051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Fibroepithelial lesions (FELs) are among the most common breast masses encountered by breast radiologists and pathologists. They encompass a spectrum of benign and malignant lesions, including fibroadenomas (FAs) and phyllodes tumors (PTs). FAs are typically seen in young premenopausal women, with a peak incidence at 20-30 years of age, and have imaging features of oval circumscribed hypoechoic masses. Although some FA variants are especially sensitive to hormonal influences and can exhibit rapid growth (eg, juvenile FA and lactational adenomas), most simple FAs are slow growing and involute after menopause. PTs can be benign, borderline, or malignant and are more common in older women aged 40-50 years. PTs usually manifest as enlarging palpable masses and are associated with a larger size and sometimes with an irregular shape at imaging compared with FAs. Although FA and FA variants are typically managed conservatively unless large and symptomatic, PTs are surgically excised because of the risk of undersampling at percutaneous biopsy and the malignant potential of borderline and malignant PTs. As a result of the overlap in imaging and histologic appearances, FELs can present a diagnostic challenge for the radiologist and pathologist. Radiologists can facilitate accurate diagnosis by supplying adequate tissue sampling and including critical information for the pathologist at the time of biopsy. Understanding the spectrum of FELs can facilitate and guide appropriate radiologic-pathologic correlation and timely diagnosis and management of PTs. Published under a CC BY 4.0 license. Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Meng Zhang
- From the Departments of Radiology (M.Z., F.K.A., J.H.P., S.J.S., S.H.G., K.M., J.C.H.) and Pathology (H.H.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
| | - Firouzeh K Arjmandi
- From the Departments of Radiology (M.Z., F.K.A., J.H.P., S.J.S., S.H.G., K.M., J.C.H.) and Pathology (H.H.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
| | - Jessica H Porembka
- From the Departments of Radiology (M.Z., F.K.A., J.H.P., S.J.S., S.H.G., K.M., J.C.H.) and Pathology (H.H.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
| | - Stephen J Seiler
- From the Departments of Radiology (M.Z., F.K.A., J.H.P., S.J.S., S.H.G., K.M., J.C.H.) and Pathology (H.H.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
| | - Sally H Goudreau
- From the Departments of Radiology (M.Z., F.K.A., J.H.P., S.J.S., S.H.G., K.M., J.C.H.) and Pathology (H.H.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
| | - Kanwal Merchant
- From the Departments of Radiology (M.Z., F.K.A., J.H.P., S.J.S., S.H.G., K.M., J.C.H.) and Pathology (H.H.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
| | - Helena Hwang
- From the Departments of Radiology (M.Z., F.K.A., J.H.P., S.J.S., S.H.G., K.M., J.C.H.) and Pathology (H.H.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
| | - Jody C Hayes
- From the Departments of Radiology (M.Z., F.K.A., J.H.P., S.J.S., S.H.G., K.M., J.C.H.) and Pathology (H.H.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
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Bradley M, Miles B, Young P, He J, Nguyen QD. Distinguishing Fibroepithelial Lesions Requires Clinical, Imaging, and Pathology Correlation. Cureus 2023; 15:e47673. [PMID: 38021664 PMCID: PMC10672401 DOI: 10.7759/cureus.47673] [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: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Phyllodes tumor (PT) is a rare tumor that can present as benign, borderline, or malignant. These tumors arise from the breast stroma, similar to fibroadenomas. Phyllodes tumors and fibroadenomas often have overlapping features in both radiological imaging and pathologic analysis. As a result, these two lesions are often difficult to differentiate and require the correlation of multiple modalities, including clinical context, radiologic imaging, and histological evaluation. This article presents a case of a borderline phyllodes tumor in a 51-year-old female, with the inclusion of its radiologic and pathologic images and performed treatment. The goal of this article is to provide a review of the clinical presentation, diagnostic imaging and pathology features, treatment, and management of a phyllodes tumor and compare and contrast this against the more common fibroadenomas, in order to provide aid for differentiating these two breast lesions.
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Affiliation(s)
- Megan Bradley
- John Sealy School of Medicine, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Brittany Miles
- John Sealy School of Medicine, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Peter Young
- Radiology, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Jing He
- Pathology, University of Texas Medical Branch at Galveston, Galveston, USA
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Mubarak F, Malick A, Sattar AK. Breast development and disorders in children and adolescents. Curr Probl Pediatr Adolesc Health Care 2023; 53:101441. [PMID: 37914550 DOI: 10.1016/j.cppeds.2023.101441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Breast masses are infrequently encountered in pediatric and adolescent populations. Most breast masses in children are benign entities arising from embryological defects which can be managed once breast development is complete. Diagnostic and management dilemmas arise when fibroepithelial lesions of the breast are seen in clinical practice. Differentiation between a fibroadenoma and a phyllodes tumor is important to guide management. Breast cancer in children under 18 years of age is extremely rare and invasive diagnostic testing and aggressive management is only recommended when clinical suspicion of malignancy is very high. Patient and caregiver counseling plays an important role in the management of these diseases. While adult-onset breast diseases have been studied very closely, there is a dearth of literature on pediatric breast anomalies. This review aims to provide a scoping overview of the available literature on benign, fibroepithelial, and malignant lesions of the breast in pediatric and adolescent populations to help guide physicians and surgeons with decision-making regarding the diagnosis and management of pediatric breast diseases.
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Affiliation(s)
- Fatima Mubarak
- Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Ayesha Malick
- Medical College, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Abida K Sattar
- Aga Khan University, Department of Surgery, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan.
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Basara Akin I, Ozgul HA, Altay C, Guray Durak M, Aksoy SO, Sevinc AI, Secil M, Gulmez H, Balci P. Machine Learning-Based Ultrasound Texture Analysis in Differentiation of Benign Phyllodes Tumors from Borderline-Malignant Phyllodes Tumors. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2023; 44:318-326. [PMID: 34674218 DOI: 10.1055/a-1640-9508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE Phyllodes tumors (PTs) are uncommon fibroepithelial breast lesions that are classified as three different forms as benign phyllodes tumor (BPT), borderline phyllodes tumor (BoPT), and malignant phyllodes tumor (MPT). Conventional radiologic methods make only a limited contribution to exact diagnosis, and texture analysis data increase the diagnostic performance. In this study, we aimed to evaluate the contribution of texture analysis of US images (TAUI) of PTs in order to discriminate between BPTs and BoPTs-MPTs. METHODS The number of patients was 63 (41 BPTs, 12 BoPTs, and 10 MPTs). Patients were divided into two groups (Group 1-BPT, Group 2-BoPT/MPT). TAUI with LIFEx software was performed retrospectively. An independent machine learning approach, MATLAB R2020a (Math- Works, Natick, Massachusetts) was used with the dataset with p < 0.004. Two machine learning approaches were used to build prediction models for differentiating between Group 1 and Group 2. Receiver operating characteristics (ROC) curve analyses were performed to evaluate the diagnostic performance of statistically significant texture data between phyllodes subgroups. RESULTS In TAUI, 10 statistically significant second order texture values were identified as significant factors capable of differentiating among the two groups (p < 0.05). Both of the models of our dataset make a diagnostic contribution to the discrimination between BopTs-MPTs and BPTs. CONCLUSION In PTs, US is the main diagnostic method. Adding machine learning-based TAUI to conventional US findings can provide optimal diagnosis, thereby helping to choose the correct surgical method. Consequently, decreased local recurrence rates can be achieved.
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Affiliation(s)
- Isil Basara Akin
- Radiology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | | | - Canan Altay
- Radiology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Merih Guray Durak
- Pathology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | | | - Ali Ibrahim Sevinc
- General Surgery, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Mustafa Secil
- Radiology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Hakan Gulmez
- Family Medicine, İzmir Democracy University, Izmir, Turkey
| | - Pinar Balci
- Radiology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
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Shi Z, Ma Y, Ma X, Jin A, Zhou J, Li N, Sheng D, Chang C, Chen J, Li J. Differentiation between Phyllodes Tumors and Fibroadenomas through Breast Ultrasound: Deep-Learning Model Outperforms Ultrasound Physicians. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23115099. [PMID: 37299826 DOI: 10.3390/s23115099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/14/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023]
Abstract
The preoperative differentiation of breast phyllodes tumors (PTs) from fibroadenomas (FAs) plays a critical role in identifying an appropriate surgical treatment. Although several imaging modalities are available, reliable differentiation between PT and FA remains a great challenge for radiologists in clinical work. Artificial intelligence (AI)-assisted diagnosis has shown promise in distinguishing PT from FA. However, a very small sample size was adopted in previous studies. In this work, we retrospectively enrolled 656 breast tumors (372 FAs and 284 PTs) with 1945 ultrasound images in total. Two experienced ultrasound physicians independently evaluated the ultrasound images. Meanwhile, three deep-learning models (i.e., ResNet, VGG, and GoogLeNet) were applied to classify FAs and PTs. The robustness of the models was evaluated by fivefold cross validation. The performance of each model was assessed by using the receiver operating characteristic (ROC) curve. The area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were also calculated. Among the three models, the ResNet model yielded the highest AUC value, of 0.91, with an accuracy value of 95.3%, a sensitivity value of 96.2%, and a specificity value of 94.7% in the testing data set. In contrast, the two physicians yielded an average AUC value of 0.69, an accuracy value of 70.7%, a sensitivity value of 54.4%, and a specificity value of 53.2%. Our findings indicate that the diagnostic performance of deep learning is better than that of physicians in the distinction of PTs from FAs. This further suggests that AI is a valuable tool for aiding clinical diagnosis, thereby advancing precision therapy.
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Affiliation(s)
- Zhaoting Shi
- Department of Oncology, Shanghai Medical College, Fudan University, No. 270, Dong'an Road, Xuhui District, Shanghai 200032, China
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, No. 270, Dong'an Road, Xuhui District, Shanghai 200032, China
| | - Yebo Ma
- Shanghai Key Laboratory of Multidimensional Information Processing, School of Communication and Electronic Engineering, East China Normal University, No. 500, Dongchuan Road, Shanghai 200241, China
| | - Xiaowen Ma
- Department of Oncology, Shanghai Medical College, Fudan University, No. 270, Dong'an Road, Xuhui District, Shanghai 200032, China
- Department of Radiology, Fudan University Shanghai Cancer Center, No. 270, Dong'an Road, Xuhui District, Shanghai 200032, China
| | - Anqi Jin
- Department of Oncology, Shanghai Medical College, Fudan University, No. 270, Dong'an Road, Xuhui District, Shanghai 200032, China
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, No. 270, Dong'an Road, Xuhui District, Shanghai 200032, China
| | - Jin Zhou
- Department of Oncology, Shanghai Medical College, Fudan University, No. 270, Dong'an Road, Xuhui District, Shanghai 200032, China
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, No. 270, Dong'an Road, Xuhui District, Shanghai 200032, China
| | - Na Li
- Department of Oncology, Shanghai Medical College, Fudan University, No. 270, Dong'an Road, Xuhui District, Shanghai 200032, China
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, No. 270, Dong'an Road, Xuhui District, Shanghai 200032, China
| | - Danli Sheng
- Department of Oncology, Shanghai Medical College, Fudan University, No. 270, Dong'an Road, Xuhui District, Shanghai 200032, China
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, No. 270, Dong'an Road, Xuhui District, Shanghai 200032, China
| | - Cai Chang
- Department of Oncology, Shanghai Medical College, Fudan University, No. 270, Dong'an Road, Xuhui District, Shanghai 200032, China
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, No. 270, Dong'an Road, Xuhui District, Shanghai 200032, China
| | - Jiangang Chen
- Shanghai Key Laboratory of Multidimensional Information Processing, School of Communication and Electronic Engineering, East China Normal University, No. 500, Dongchuan Road, Shanghai 200241, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, No. 1200, Cailun Road, Pudong District, Shanghai 201203, China
| | - Jiawei Li
- Department of Oncology, Shanghai Medical College, Fudan University, No. 270, Dong'an Road, Xuhui District, Shanghai 200032, China
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, No. 270, Dong'an Road, Xuhui District, Shanghai 200032, China
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12
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Felsen A, Maldjian C, Hodges L, Gupta A, Fineberg S. Fibroepithelial Lesion Spectrum: A Case Report Documenting a Possible Transformation to a Malignant Phyllodes Tumor. Cureus 2023; 15:e38252. [PMID: 37252609 PMCID: PMC10225156 DOI: 10.7759/cureus.38252] [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: 08/09/2022] [Indexed: 05/31/2023] Open
Abstract
We discuss the radiological-pathological aspects of a rare case of transformation of a presumed fibroadenoma (FA) to a malignant phyllodes tumor (PT) and review the literature. Phyllodes tumors often show heterogeneous histologic features with some areas indistinguishable on core needle biopsy. A core biopsy is often a small representation of a larger lesion. As such, a complete excisional biopsy is often needed for a definitive pathologic diagnosis. Careful clinical and imaging correlation and follow-up are necessary, even in a benign fibroepithelial lesion (FEL).
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Affiliation(s)
- Amanda Felsen
- Radiology, Albert Einstein College of Medicine, Bronx, USA
- Medicine, Montefiore New Rochelle Hospital, New Rochelle, USA
| | - Catherine Maldjian
- Radiology, Montefiore Medical Center, Bronx, USA
- Radiology, Albert Einstein College of Medicine, Bronx, USA
| | - Laura Hodges
- Radiology, Montefiore Medical Center, Bronx, USA
- Radiology, Albert Einstein College of Medicine, Bronx, USA
| | - Anjuli Gupta
- Surgery, Montefiore Medical Center, Bronx, USA
- Surgery, Albert Einstein College of Medicine, Bronx, USA
| | - Susan Fineberg
- Pathology, Montefiore Medical Center, Bronx, USA
- Pathology, Albert Einstein College of Medicine, Bronx, USA
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Jha N, Maharjan M, Rimal R, Huda F, Singh A. Osteosarcoma Originating From a Malignant Phyllodes Tumor: A Case Report of a Rare Malignancy. Cureus 2023; 15:e37737. [PMID: 37213960 PMCID: PMC10198583 DOI: 10.7759/cureus.37737] [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: 04/17/2023] [Indexed: 05/23/2023] Open
Abstract
Fibroepithelial tumors are common in the breast; however, the frequency of malignancy is much less as compared to the epithelial counterpart. Malignant phyllodes are infrequent, and the proportion undergoing heterologous differentiation is very rare. Extensive sampling and astute examination are of utmost importance so as not to miss this lesion. The prognosis of these tumors is worse compared to cases where no heterologous transformation is seen.
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Affiliation(s)
- Nishi Jha
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, IND
| | - Monika Maharjan
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, IND
| | - Rajesh Rimal
- Department of Radiology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Farhanul Huda
- Department of General Surgery, All India Institute of Medical Sciences, Rishikesh, IND
| | - Ashok Singh
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, IND
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14
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Choi JS, Ko EY, Kim MJ, Ko ES, Han BK. Combined use of shear-wave elastography and Doppler ultrasonography in equivocal fibroepithelial lesions of the breast diagnosed by core needle biopsy. Ultrasonography 2023; 42:31-40. [PMID: 36353790 PMCID: PMC9816696 DOI: 10.14366/usg.22008] [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] [Received: 01/17/2022] [Accepted: 05/17/2022] [Indexed: 11/11/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the diagnostic value of shear-wave elastography (SWE) combined with Doppler ultrasonography (US) in selecting equivocal breast fibroepithelial lesions (FELs) for follow-up without further excision. METHODS A retrospective analysis was conducted of 88 patients with equivocal breast FELs (FELs with the possibility of both fibroadenoma [FA] and phyllodes tumor [PT]) diagnosed by core needle biopsy (CNB). For post-CNB treatment, surgical or vacuum-assisted excision was performed on 88 equivocal FELs, of which 56 were diagnosed as FAs and 32 as PTs on histopathology. Mean elasticity (Emean) and vascularity were determined using SWE and Doppler US. The diagnostic performances of B-mode US, SWE, and Doppler US were calculated to differentiate FAs and PTs in the excised equivocal FELs. RESULTS In the excised equivocal FELs diagnosed by CNB, FAs showed significantly lower median Emean values (36.4 vs. 66.7 kPa, P=0.005) and more frequent low vascularity (0-1 vessel flow signal) (P<0.001) than PTs. For the differentiation of FAs and PTs, the combination of Emean of >60.9 kPa and high vascularity (≥2 vessel flows) showed a sensitivity and negative predictive value of 100%, as well as better performance in other diagnostic values than B-mode US alone (Breast Imaging Reporting and Data System ≥4A) (all P<0.05). CONCLUSION Equivocal breast FELs showing both low elasticity and low vascularity were not upgraded to PTs upon further excision. Therefore, the combination of SWE and color Doppler US mode might help select patients with equivocal FELs for whom further excision is unnecessary.
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Affiliation(s)
- Ji Soo Choi
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea,Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Eun Young Ko
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea,Correspondence to: Eun Young Ko, MD, PhD, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Tel. +82-2-3410-2519 Fax. +82-2-3410-2509 E-mail:
| | - Min-Ji Kim
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Eun Sook Ko
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Boo-Kyung Han
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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15
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Discrimination between phyllodes tumor and fibro-adenoma: Does artificial intelligence-aided mammograms have an impact? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00734-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The indulgence of artificial intelligence (AI) has been considered recently in the work up for the detection and diagnosis of breast cancer through algorithms that could supply diagnosis as the radiologist do. The algorithm learns from a supervised and continuous input of large and new data sets unlike the standard programming, which requires clear step-by-step instructions. The aim of this study is to assess the ability of AI scanned mammograms to aid the ultrasound in the discrimination between phyllodes tumors and fibro-adenomas.
Results
This is a retrospective analysis included 374 proven phyllodes tumors (PT) and fibro-adenomas (FA). Digital mammogram and breast ultrasound was performed for all the cases and each breast was given a “Breast Imaging Reporting and Data System” (BI-RADS) score. Included mammograms were scanned by AI with resultant a qualitative heatmap and a quantitative abnormality scoring of suspicion percentage.
The study included 164 PT (43.9%) and 210 FA (56.1%). BI-RADS category 2 was assigned in 40.1%, category 3 in 38.2%, category 4 in 18.5% and category 5 in 3.2% with median value of the AI abnormality scoring of 23%, 44%, 65% and 90% respectively. Sensitivity and specificity of the conventional imaging were 59.2% and 75.8% respectively. The AI abnormality scoring of 49.5% upgraded the sensitivity to 89.6% and specificity to 94.8% in the ability to discriminate PT from FA masses.
Conclusion
Artificial intelligence-aided mammograms could be used as method of distinction between PT from FA detected on sono-mammogram. The color hue and the quantification of the abnormality scoring percentage could be used as a one setting method for specification and so guide clinicians in their decision of conservative management or the choice of the surgical procedure.
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16
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Orguc S, Mavili S, Açar ÇR, Aydede H, Kandiloğlu AR. Contrast-enhanced spectral mammographic findings of phyllodes tumor of the breast. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [PMCID: PMC9101982 DOI: 10.1186/s43055-022-00789-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Phyllodes tumors of breast are rare fibroepithelial neoplasms. They have similar radiological findings with fibroadenomas. While fibroadenomas are benign lesions, phyllodes tumors may have malignant potential. Therefore, any imaging findings to differentiate fibroadenoma from phyllodes tumor are valuable. Case presentation A 51-year-old female patient was admitted to our clinic with the complaint of a palpable mass. Tru-Cut biopsy resulted as phyllodes tumor, and excision was recommended. However, the patient neglected herself during the COVID-19 pandemic, and 20 months later, she presented with a huge and complex mass. On CESM imaging, cystic areas and clefts were identified. The case was diagnosed as borderline phyllodes tumor. Conclusions Although MRI findings of phyllodes tumor are well known and reported many times, there is no information about CESM findings of this tumor in literature. Bubbly appearance on CESM is useful finding in the diagnosis of phyllodes tumor of breast.
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17
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Phyllodes Tumors of the Breast: A Rare Lesion with Still-Evolving Prognostic Features and Clinical Management. CURRENT RADIOLOGY REPORTS 2022. [DOI: 10.1007/s40134-022-00403-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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18
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Zhang M, Compton L, Hwang H, Hayes JC. Radiologic-Pathologic Correlation of Fibroepithelial Lesions: A Pictorial Review. JOURNAL OF BREAST IMAGING 2022; 4:513-519. [PMID: 38416944 DOI: 10.1093/jbi/wbac026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Indexed: 03/01/2024]
Abstract
Fibroepithelial lesions (FEL) of the breast encompass a spectrum of masses ranging from benign to malignant. Although these lesions are on the same biologic spectrum, differences in their clinical behaviors necessitate different management approaches. While imaging features are nonspecific, small size (less than 3 cm), oval shape, circumscribed margins, growth in diameter less than 20% in six months, and homogeneous echotexture on US favor fibroadenoma (FA). Conversely, larger size (3 cm or larger), rapid growth, irregular shape, noncircumscribed margins, and heterogeneous echotexture suggest possible phyllodes tumor (PT). Histopathologically, increased stromal cellularity, stromal atypia, and mitotic activity characterize PT, while FA typically lack these features. In this review, we summarize the imaging and pathology characteristics of nonmalignant FEL, including simple, juvenile, and complex FA, and benign and borderline PT and highlight the collaborative role of radiologists and pathologists in informing diagnosis and clinical management.
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Affiliation(s)
- Meng Zhang
- The University of Texas Southwestern Medical Center, Department of Radiology, Dallas, TX, USA
| | - Lindsay Compton
- The University of Texas Southwestern Medical Center, Department of Radiology, Dallas, TX, USA
| | - Helena Hwang
- The University of Texas Southwestern Medical Center, Department of Pathology, Dallas, TX, USA
| | - Jody C Hayes
- The University of Texas Southwestern Medical Center, Department of Radiology, Dallas, TX, USA
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19
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Malignant Phyllodes Tumor Complicating Precious Pregnancy—Management Dilemma. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03104-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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20
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Boulnemour K, Buoniconti P, Cha SJ, Johnson T. Myositis ossificans of the breast - A rare case report with radiologic-pathologic correlation. Radiol Case Rep 2022; 17:2018-2022. [PMID: 35432665 PMCID: PMC9010686 DOI: 10.1016/j.radcr.2022.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/09/2022] [Indexed: 11/23/2022] Open
Abstract
Myositis ossificans is a pathologic process of ossification in soft tissues. The breast is an exceptionally rare location for myositis ossificans with less than 5 cases documented in the English literature. We present a case of a 66-year-old woman with myositis ossificans of the left breast and no known initiating trauma. The significance of the progression of clinical and radiological findings are discussed in detail. This case shows the importance of radiology for identifying unique pathology as well as close radiological follow up.
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21
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Li T, Li Y, Yang Y, Li J, Hu Z, Wang L, Pu W, Wei T, Lu M. Logistic regression analysis of ultrasound findings in predicting the malignant and benign phyllodes tumor of breast. PLoS One 2022; 17:e0265952. [PMID: 35325009 PMCID: PMC8947023 DOI: 10.1371/journal.pone.0265952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 03/10/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate ultrasound characteristics in the prediction of malignant and benign phyllodes tumor of the breast (PTB) by using Logistic regression analysis. METHODS 79 lesions diagnosed as PTB by pathology were analyzed retrospectively. The ultrasound features of PTB were recorded and compared between benign and malignant tumors by using single factor and multiple stepwise Logistic regression analysis. Moreover, the Logistic regression model for malignancy prediction was also established. RESULTS There were 79 patients with PTB, including 39 benign PTBs and 40 malignant PTBs (33 borderline PTBs and 7 malignant PTBs by pathologic classification). The area under the ROC curve (AUC) of lesion size and age were 0.737 and 0.850 respectively. There were significant differences in age, lesion size, shape, internal echo, liquefaction, and blood flow between malignant and benign PTBs by using single-factor analysis (P<0.05). Age, internal echo, and liquefaction were significant features by using Logistic regression analysis. The corresponding regression equation In (p/(1 - p) = -3.676+2.919 internal echo +3.029 liquefaction +4.346 age). CONCLUSION Internal echo, age, and liquefaction are independent ultrasound characteristics in predicting the malignancy of PTBs.
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Affiliation(s)
- Tingting Li
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yanjie Li
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yingqi Yang
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Juan Li
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - ZiYue Hu
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Lu Wang
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Wei Pu
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Ting Wei
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Man Lu
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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22
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Ofri A, Stuart KE, Chan B, Mak C, Warrier S, Bhadri V, Mander-Jones T, O'Toole S. Diagnosis and management of phyllodes tumours for the surgeon: An algorithm. Surgeon 2022; 20:e355-e365. [PMID: 35148937 DOI: 10.1016/j.surge.2022.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 12/02/2021] [Accepted: 01/07/2022] [Indexed: 11/17/2022]
Abstract
A Phyllodes Tumour (PT) is an uncommon fibroepithelial lesion, with three histological grades - benign, borderline and malignant. PTs cause significant challenges in diagnosis, management and prognostication. Recent publications have clarified the definitions and prognostication of PTs. Contemporary data currently challenge international guidelines on PT management. We performed an in-depth literature review to develop a best-practice management algorithm for PTs. Diagnostic recommendations are that neither current imaging techniques, nor fine-needle biopsies, can reliably diagnose a PT. Core needle biopsy is the optimal diagnostic technique. Indeterminate or suspicious lesions are recommended to undergo an excisional biopsy due to the inherently heterogeneous nature of PTs. Management guidelines are that benign PTs should be completely excised, although an involved margin is acceptable in select situations. Borderline PTs should have a clear margin on excision due to their higher risk of recurrence, as well as the potential for a recurrence to progress to a malignant PT. In malignant PTs, a margin of 3 mm is acceptable as there is no reduction in recurrence risk if margins are >3 mm. Routine axillary surgery is not indicated in PTs, with axillary surgery only indicated in a histologically-confirmed positive axilla. Adjuvant treatment recommendations are that borderline and malignant PTs should be discussed at MDT, with radiotherapy considered in both. Chemotherapy should be discussed in malignant PT patients. In summary, we have developed an up-to-date simple algorithm to guide the surgeon's management of patients diagnosed with PTs and reduce excessive surgery.
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Affiliation(s)
- Adam Ofri
- Department of Surgery, Royal North Shore Hospital, Reserve Road, St Leonards, NSW 2065, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Kirsty E Stuart
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, 166-174 Hawkesbury Rd, Westmead, NSW 2145, Australia; Westmead Breast Cancer Institute, Block F/189 Cnr Hawkesbury & Darcy Rd, Westmead, NSW 2145, Australia; Western Clinical School, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Belinda Chan
- Department of Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Rd, Camperdown, NSW 2050, Australia; Strathfield Private Hospital, 3 Everton Rd, Strathfield, NSW 2135, Australia
| | - Cindy Mak
- Department of Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Rd, Camperdown, NSW 2050, Australia; Royal Prince Alfred Hospital Institute of Academic Surgery, Camperdown, NSW 2050, Australia; Mater Hospital, 25 Rocklands Rd, North Sydney, NSW 2060, Australia
| | - Sanjay Warrier
- Department of Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Rd, Camperdown, NSW 2050, Australia; Royal Prince Alfred Hospital Institute of Academic Surgery, Camperdown, NSW 2050, Australia
| | - Vivek Bhadri
- Department of Medical Oncology, Chris O'Brien Lifehouse, 119-143 Missenden Rd, Camperdown, NSW 2050, Australia
| | - Tim Mander-Jones
- Department of Radiology, Concord Repatriation General Hospital, Hospital Rd, Concord, NSW 2139, Australia; Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
| | - Sandra O'Toole
- St Vincent's Clinical School, University of New South Wales, Sydney, NSW 2052, Australia; The Kinghorn Cancer Centre and Cancer Research Division, Garvan Institute of Medical Research, 370 Victoria St, Darlinghurst, NSW 2010, Australia; Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Johns Hopkins Dr, Camperdown, NSW 2050, Australia; Western Sydney University, Campbelltown, NSW 2560, Australia
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23
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Management of Multiple Breast Fibroadenomas, Literature Review. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03297-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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24
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Radiologic and Pathologic Correlation for Benign Breast Processes. CURRENT BREAST CANCER REPORTS 2021. [DOI: 10.1007/s12609-021-00438-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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25
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Huayanay Espinoza JL, Mego Ramírez FN, Guerra Miller H, Guelfguat M. An Overview of Rare Breast Neoplasms with Radiologic-Pathologic Correlation. CURRENT BREAST CANCER REPORTS 2021. [DOI: 10.1007/s12609-021-00433-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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26
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Jin Y, Bi L, Yang R, Jiang T, Zhang X, Li S. Breast osteosarcoma originating from a malignant phyllodes tumor: A case report of a rare neoplasm. Medicine (Baltimore) 2021; 100:e27908. [PMID: 34964761 PMCID: PMC8615303 DOI: 10.1097/md.0000000000027908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/03/2021] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Malignant phyllodes tumors with osteosarcomatous transformation are exceedingly rare. The clinical manifestations are similar to those associated with benign giant calcification, resulting in nonspecific and complex clinical symptoms. PATIENT CONCERNS A 59-year-old woman presented with a firm, painless, movable, 5.0 × 4.0 cm lump in the lower inner quadrant of the left breast that she had detected 1 month prior. DIAGNOSES Breast osteosarcoma originating from a malignant phyllodes tumor was confirmed by histopathologic and immunohistochemical evaluation. INTERVENTIONS The patient underwent a wide local excision. OUTCOMES The patient recovered uneventfully and was discharged after the operation. The 6-month postoperative follow-up assessment revealed no evidence of recurrence. LESSONS Diagnosing malignant phyllodes tumors with osteosarcomatous transformation requires a high level of suspicion and awareness by both surgeons and pathologists. They should be aware of the extent of such disease, which might be mistaken as benign giant calcification. Medical history and imaging findings are important for accurate diagnosis. Phyllodes tumor with an osteosarcomatous component is an aggressive neoplasm associated with distant metastasis. Delayed diagnosis and insufficient excision might negatively impact both treatment and survival.
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Affiliation(s)
- Ying Jin
- Department of Breast Surgery, First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Lirong Bi
- Department of Pathology, First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Ruming Yang
- Department of Breast Surgery, First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Tinghan Jiang
- Department of Breast Surgery, First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Xiaoxiao Zhang
- Department of Breast Surgery, First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Sijie Li
- Department of Breast Surgery, First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
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Khalid IB, Parvaiz MA, Sarwar A, Shaikh OS, Javed N, Fatima A. A leafy surprise: Case report of male breast malignant phyllodes. Int J Surg Case Rep 2021; 88:106536. [PMID: 34715464 PMCID: PMC8577468 DOI: 10.1016/j.ijscr.2021.106536] [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] [Received: 09/22/2021] [Revised: 10/16/2021] [Accepted: 10/19/2021] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Phyllodes tumor is a biphasic fibroepithelial tumor which accounts for less than 1% of all breast neoplasms. We aim to raise awareness among clinicians that a male breast lump may be indicative of underlying sinister pathology and therefore, should be investigated thoroughly. CASE PRESENTATION A 62 year old male presented in clinic with right beast lump for the last 6 weeks. A preoperative diagnosis of spindle cell tumor was made on core needle biopsy. Neoadjuvant chemotherapy was administered in order to downsize the tumor as it was inseparable from underlying muscle. A post-operative diagnosis of malignant phyllodes was made following mastectomy. As the tumor was 1 mm from the deep margin, adjuvant radiotherapy was administered. CLINICAL DISCUSSION Differential diagnoses of malignant phyllodes include metaplastic carcinomas metastatic/primary sarcomas and fibroadenomas. Metaplastic carcinomas are morphologically heterogeneous and include adenosquamous carcinoma, squamous cell carcinoma and spindle cell carcinoma. In some malignant phyllodes, extensive stromal proliferation can make detection of epithelial component very difficult. This highlights the limitation of core biopsy in establishing an accurate preoperative diagnosis. The standard treatment for phyllodes treatment is surgical resection with margins of 1 cm or more. Adjuvant radiotherapy is used in cases with threatened margins. CONCLUSION Malignant phyllodes tumor of breast can exist in men, and its accurate pre-operative diagnosis is difficult given the limitations of core biopsy. This case report draws attention to the challenges associated with the diagnosis of this rare condition and highlights the role of different treatment modalities in its management.
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Affiliation(s)
- Ibtissam Bin Khalid
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, 7A Block R-3, M.A. Johar Town, Lahore, Pakistan.
| | - Muhammad Asad Parvaiz
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, 7A Block R-3, M.A. Johar Town, Lahore, Pakistan
| | - Albash Sarwar
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, 7A Block R-3, M.A. Johar Town, Lahore, Pakistan.
| | - Omair Shahid Shaikh
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, 7A Block R-3, M.A. Johar Town, Lahore, Pakistan.
| | - Nida Javed
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, 7A Block R-3, M.A. Johar Town, Lahore, Pakistan
| | - Arooj Fatima
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, 7A Block R-3, M.A. Johar Town, Lahore, Pakistan
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28
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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: 18] [Impact Index Per Article: 6.0] [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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Tu He Ta Mi Shi ME, Wang N, Yao Q, Dong SS, Feng X, Zhao J, Zou H, Pang LJ, Qi Y. A Case of Phyllodes Tumor of the Breast with Mixed Liposarcoma: Case Report and Literature Review. Onco Targets Ther 2021; 14:3003-3011. [PMID: 33986601 PMCID: PMC8110257 DOI: 10.2147/ott.s298379] [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] [Received: 12/21/2020] [Accepted: 02/25/2021] [Indexed: 11/26/2022] Open
Abstract
Phyllodes tumors (PTs) account for less than 1% of breast tumors, and malignant PTs account for even less. Here, we described an unusual case of malignant PT with mixed liposarcoma (myxoid liposarcoma [MLP] and pleomorphic liposarcoma [PLP]). A 52-year-old woman discovered a small lump in her left breast. Twenty years later, the lump suddenly grew within 1 month. Mammography showed space-occupying lesions of the left breast. Histologically, the tumor was characterized by hypercellular stroma covering the epithelium and protrusion of the myoepithelium into the cyst to form a lobulated structure; regions of loose mucus and hypercellular structures alternated. A region of peripheral benign fibroadenoma was also observed, and many stellate and spindle cells or signet ring-like cells were identified in loose areas. Some areas showed a characteristic thin branching vascular pattern. In the cell-rich area, adipocytes and odd megakaryocytes were observed. Atypical mitotic figures were observed in the cell-rich and mucus areas (16 mitoses/10 high-power fields [HPF] and 2 mitoses/10 HPF, respectively). In the immunohistochemical analysis, a small number of tumor cells were positive for AE1/3 and vimentin, whereas all cells were negative for cytokeratin 34βE12, E-cadherin, p63, estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, and S-100, ruling out the possibility of metaplastic carcinoma. Interestingly, cyclin-dependent kinase 4, mouse double minute 2 (MDM2), and p16 were strongly positive in both loose mucus and cell-rich areas. However, the fluorescence in situ hybridization test results showed that MDM2 was not amplified. Combined with morphological characteristics, these findings supported that the tumor was a mixed malignant PT with MLP and PLP. Our patient did not receive radiation therapy, and after 47 months of follow-up, no recurrence or metastasis occurred. This case report serves to expand the morphologic spectrum of mixed malignant PT with liposarcoma.
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Affiliation(s)
- Mei Er Tu He Ta Mi Shi
- Department of Pathology, Shihezi University School of Medicine and the First Affiliated Hospital to Shihezi University School of Medicine, Shihezi, Xinjiang, 832002, People's Republic of China
| | - Ning Wang
- Department of Pathology, Shihezi University School of Medicine and the First Affiliated Hospital to Shihezi University School of Medicine, Shihezi, Xinjiang, 832002, People's Republic of China
| | - Qing Yao
- Department of Pathology, Shihezi University School of Medicine and the First Affiliated Hospital to Shihezi University School of Medicine, Shihezi, Xinjiang, 832002, People's Republic of China
| | - Shuang-Shuang Dong
- Department of Pathology, Shihezi University School of Medicine and the First Affiliated Hospital to Shihezi University School of Medicine, Shihezi, Xinjiang, 832002, People's Republic of China
| | - Xiao Feng
- Department of Pathology, Shihezi University School of Medicine and the First Affiliated Hospital to Shihezi University School of Medicine, Shihezi, Xinjiang, 832002, People's Republic of China
| | - Jin Zhao
- Department of Pathology, Shihezi University School of Medicine and the First Affiliated Hospital to Shihezi University School of Medicine, Shihezi, Xinjiang, 832002, People's Republic of China
| | - Hong Zou
- Department of Pathology, Shihezi University School of Medicine and the First Affiliated Hospital to Shihezi University School of Medicine, Shihezi, Xinjiang, 832002, People's Republic of China
| | - Li-Juan Pang
- Department of Pathology, Shihezi University School of Medicine and the First Affiliated Hospital to Shihezi University School of Medicine, Shihezi, Xinjiang, 832002, People's Republic of China
| | - Yan Qi
- Department of Pathology, Shihezi University School of Medicine and the First Affiliated Hospital to Shihezi University School of Medicine, Shihezi, Xinjiang, 832002, People's Republic of China.,Department of Pathology, Central People's Hospital of Zhanjiang and Zhanjiang Central Hospital, Guangdong Medical University, Zhanjiang, People's Republic of China
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Sharma S, Nwachukwu C, Wieseler C, Elsherif S, Letter H, Sharma S. MRI Virtual Biopsy of T2 Hyperintense Breast Lesions. J Clin Imaging Sci 2021; 11:18. [PMID: 33880243 PMCID: PMC8053438 DOI: 10.25259/jcis_42_2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/22/2021] [Indexed: 01/15/2023] Open
Abstract
A wide variety of benign and malignant breast processes may generate hyperintense signal at T2-weighted magnetic resonance imaging (MRI). MRI has been traditionally used in the pre-treatment planning of breast cancer, in assessing treatment response and detecting recurrence. In this comprehensive review, we describe and illustrate the MRI features of a few common and uncommon T2 hyperintense breast lesions, with an emphasis on MRI features that help to characterize lesions based on morphological features, specific appearances on T1-and T2-weighted imaging, and enhancement characteristics on the dynamic post-contrast phase that are either diagnostic or aid in narrowing the differential diagnosis.
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Affiliation(s)
- Swati Sharma
- Department of Radiology, University of Florida, Jacksonville, Florida, United States
| | - Chidi Nwachukwu
- Department of Radiology, University of Florida, Jacksonville, Florida, United States
| | - Carissa Wieseler
- Department of Radiology, University of Florida, Jacksonville, Florida, United States
| | - Sherif Elsherif
- Department of Radiology, University of Florida, Jacksonville, Florida, United States
| | - Haley Letter
- Department of Radiology, University of Florida, Jacksonville, Florida, United States
| | - Smita Sharma
- Department of Radiology, University of Florida, Jacksonville, Florida, United States
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Yaqin SMD, Shumin WMDP, Zhanfei ZMD, Xin QMD, Li LMD, Qin LMD. Sonographic Features of Borderline Phyllodes Tumor of the Breast: A Case Report. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2021. [DOI: 10.37015/audt.2021.210006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Yang P, Shi X, Li J, Qian L. Imaging features of myopericytoma of the breast: A case report and review of the literature. Radiol Case Rep 2021; 16:98-102. [PMID: 33204380 PMCID: PMC7649600 DOI: 10.1016/j.radcr.2020.10.051] [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] [Received: 08/20/2020] [Revised: 10/24/2020] [Accepted: 10/26/2020] [Indexed: 11/02/2022] Open
Abstract
Myopericytoma is a rare perivascular tumor commonly arising in the superficial soft tissue and subcutaneous tissue of the distal extremities. We report the first case of myopericytoma occurring in the breast, focusing on the imaging and histopathological characteristics of the tumor. From an imaging perspective, myopericytoma presents a well-circumscribed, marked hypervascularity, and intense enhancement after injection of contrast material. Imaging examinations, such as ultrasonography and magnetic resonance imaging, can contribute to the detection of tumor invasion to adjacent structures or distant metastases, and provide evidence for a treatment plan.
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Affiliation(s)
- PeiPei Yang
- Department of Ultrasound, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing 100050, China
| | - XianQuan Shi
- Department of Ultrasound, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing 100050, China
| | - JianMing Li
- Department of Ultrasound, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing 100050, China
| | - LinXue Qian
- Department of Ultrasound, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing 100050, China
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Vong S, Navarro SM, Darrow M, Aminololama-Shakeri S. Extramedullary Plasmacytoma of the breast in a patient with Multiple Myeloma. J Radiol Case Rep 2020; 14:14-23. [PMID: 33717400 DOI: 10.3941/jrcr.v14i12.4110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Extramedullary plasmacytoma of the breast is rare. It is important to recognize the imaging findings and include it as a differential consideration in multiple myeloma patients with a breast mass. A 74-year-old woman undergoing chemotherapy for relapsed multiple myeloma presented with a palpable mass in her right breast. A screening mammogram four months prior was unremarkable. She underwent a diagnostic right mammogram which showed two well-circumscribed hyperdense masses. An ultrasound of the right breast showed mixed echogenic masses with indistinct margins and increased vascularity. Ultrasound guided biopsy confirmed the presence of an extramedullary plasmacytoma. A follow-up whole body PET/CT demonstrated an FDG-avid right breast mass with extensive osseous metastases.
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Affiliation(s)
- Stephen Vong
- Department of Radiology, UC Davis Health, Sacramento, California, USA
| | | | - Morgan Darrow
- Department of Pathology and Laboratory Medicine, UC Davis Health, Sacramento, California, USA
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Yan Z, Gudi M, Saffari SE, Abdrashid F, Lim SH, Teo SY, Leong MY, Lee YS, Lau L, Win T, Tan PH. Preoperative radiological and histological features predict phyllodes tumor grade. Breast J 2020; 26:2122-2124. [PMID: 33064334 DOI: 10.1111/tbj.13983] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/29/2020] [Accepted: 07/08/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Zhiyan Yan
- Breast Department, KK Women's and Children's Hospital, Singapore, Singapore
| | - Mihir Gudi
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Seyed Ehsan Saffari
- Centre for Quantitative Medicine, Duke- NUS medical school, Singapore, Singapore
| | - Fazliana Abdrashid
- Breast Department, KK Women's and Children's Hospital, Singapore, Singapore
| | - Swee Ho Lim
- Breast Department, KK Women's and Children's Hospital, Singapore, Singapore
| | - Sze Yiun Teo
- Breast Imaging Department, KK Women's and Children's Hospital, Singapore, Singapore
| | - May Ying Leong
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Yien Sien Lee
- Breast Imaging Department, KK Women's and Children's Hospital, Singapore, Singapore
| | - LiChing Lau
- Breast Imaging Department, KK Women's and Children's Hospital, Singapore, Singapore
| | - Thida Win
- Breast Imaging Department, KK Women's and Children's Hospital, Singapore, Singapore
| | - Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Singapore, Singapore
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Basara Akin I, Ozgul H, Simsek K, Altay C, Secil M, Balci P. Texture Analysis of Ultrasound Images to Differentiate Simple Fibroadenomas From Complex Fibroadenomas and Benign Phyllodes Tumors. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1993-2003. [PMID: 32329531 DOI: 10.1002/jum.15304] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/15/2020] [Accepted: 03/26/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) category 4A lesions can be distinguished from BI-RADS 3 lesions with main ultrasound (US) findings such as a well-defined contour, round/oval shape, and parallel orientation with a homogeneous echo pattern. Breast Imaging Reporting and Data System 4A solid masses might be diagnosed as simple fibroadenomas (SFAs), complex fibroadenomas (CFAs), or benign phyllodes tumors (BPTs). Complex fibroadenomas have an increased risk of invasive cancer development than SFAs, and BPTs have a risk of borderline-malignant phyllodes tumor transformation; both of them are surgically treated, whereas follow-up procedures are applied in SFAs. It is essential to differentiate SFAs from CFAs and BPTs. Grayscale features of these lesions include a prominent overlap. Texture analyses in breast lesions have contributions in benign-malignant lesion differentiation. In this study, we aimed to use texture analysis of US images to differentiate these benign lesions. METHODS Grayscale US features of lesions (32 SFAs, 31 CFAs, and 32 BPTs) were classified according to the BI-RADS. Texture analysis of US images with LIFEx software (http://www.lifexsoft.org) was performed retrospectively. First- and second-order histogram parameters were evaluated. RESULTS In grayscale US, the shape, orientation, and posterior acoustic characteristics had statistical significance (P < .05). In the statistical analysis, skewness, kurtosis, excess kurtosis, gray-level co-occurrence matrix (GLCM)-energy, GLCM-entropy log 2, and GLCM-entropy log 10 revealed significant differences among all 3 groups (P < .05). CONCLUSIONS As grayscale US features show prominent intersections, and treatment options differ, correct diagnosis is essential in SFAs, CFAs, and BPTs. In this study, we concluded that texture analysis of US images can discriminate SFAs from CFAs and BPTs. Texture analyses of US images is a potential candidate diagnostic tool for these lesions, and accurate diagnoses will preclude patients from undergoing unnecessary biopsies.
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Affiliation(s)
- Isil Basara Akin
- Department of Radiology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Hakan Ozgul
- Department of Radiology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Kursat Simsek
- Department of Radiology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Canan Altay
- Department of Radiology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Mustafa Secil
- Department of Radiology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Pinar Balci
- Department of Radiology, Dokuz Eylul University School of Medicine, Izmir, Turkey
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Abstract
Phyllodes tumors (PTs) of the breast are considered a rare fibroepithelial neoplasms of the breast and are considered a challenging for both pathologists and surgeons. The World Health Organization (WHO) has classified PTs histologically as benign, borderline, and malignant. PTs can be detected in all ages; however, the median age of presentation is 45 years. PTs can mimic fibroadenoma in clinical presentations. Breast imaging is also similar to fibroadenomas. Cytological diagnosis of PTs by biopsy is usually unreliable. However, a core needle biopsy is superior to fine-needle aspiration. Surgery is considered the mainstay treatment for PTs of the breast with a goal of achieving negative margins. Adjuvant chemotherapy and radiation therapy use for malignant PTs are controversial.
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Affiliation(s)
- Musaed Rayzah
- Department of Surgery, College of Medicine, Majmaah University, Majmaah, SAU
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37
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Giant fibroadenoma of the breast: A case report of a 37-year-old woman during the second trimester of pregnancy. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.707606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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38
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Jiang N, Zhong L, Zhang C, Luo X, Zhong P, Li X. Value of Conventional MRI Texture Analysis in the Differential Diagnosis of Phyllodes Tumors and Fibroadenomas of the Breast. Breast Care (Basel) 2020; 16:283-290. [PMID: 34248470 DOI: 10.1159/000508456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 05/06/2020] [Indexed: 01/30/2023] Open
Abstract
Background There is substantial overlap in MRI findings between phyllodes tumors (PTs) and fibroadenomas (FAs). Our study was performed to investigate the value of conventional MRI texture analysis in the differential diagnosis of PTs and FAs. Methods Preoperative MRI data - including axial T1WI, T2WIFS (T2WI with fat suppression), dynamic contrast-enhanced (DCE)-T1WI2min and DCE-T1WI7min (T1WI post-strengthened for 2 and 7 min, respectively, on DCE-MRI) - of 45 patients with PTs and 67 patients with FAs were retrospectively analyzed. MaZda 4.7 software was used to manually draw the maximum ROIs at the same lesion level of the above MRI images. The optimized feature selection methods included Fisher's coefficient, probability of classification error and average correction coefficient (POE + ACC), and mutual information (MI) as well as a combination of the above 3 methods (F + POE + ACC + MI [FPM]), respectively. The misclassification rates of PTs and FAs were compared between texture analysis and subjective diagnosis by radiologists. Results The DCE-T1WI7min images had the lowest misclassification rate of 10.71% (12/112). The misclassification rate for the radiologists' analysis (31.25%, 35/112) was higher than that of all the texture analysis, and there was a statistically significant difference between the radiologists' misclassification rates and those from the FPM method in terms of the T2WIFS and DCE-T1WI2min images (all p < 0.05), and for the DCE-T1WI7min images by using the Fisher and FPM methods (all p < 0.05). Conclusion Texture analysis of conventional MRI can be used as an assistant tool in providing a certain objective basis for differentiating PTs from FAs.
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Affiliation(s)
- Nianping Jiang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, China
| | - Li Zhong
- Department of Radiation Oncology, Daping Hospital, Army Medical University, Chongqing, China
| | - Chunlai Zhang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, China
| | - Xiangguo Luo
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, China
| | - Peng Zhong
- Department of Pathology, Daping Hospital, Army Medical University, Chongqing, China
| | - Xiaoguang Li
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, China
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Al-Arnawoot B, Scaranelo A, Fleming R, Kulkarni S, Menezes RJ, McCready D, Done S, Freitas V. Cellular fibroepithelial lesions diagnosed on core needle biopsy: Is there any role of clinical-sonography features helping to differentiate fibroadenomas and phyllodes tumor? J Surg Oncol 2020; 122:382-387. [PMID: 32396665 DOI: 10.1002/jso.25977] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 05/02/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The purpose of this study is to determine the role of clinico-sonographic features of breast cellular fibroepithelial lesions (CFELs) diagnosed on core needle biopsy (CNB) in the differentiation between fibroadenoma (FA) and phyllodes. MATERIALS AND METHODS Results of consecutive women with a CNB showing CFEL from 2005 to 2010 were retrospectively reviewed. Clinical and sonographic findings were compared with surgical outcomes. Chi-square and Fisher's exact tests were used followed by a regression model for statistical analysis. RESULTS A total of 131 women with 134 CFEL were included in the study; 89 (66%) were FAs and 45 (34%) were phyllodes (32 benign; 13 malignant). Significant predictors of increased risk of phyllodes tumor were patient age equal to or greater than 50 years (P = .021) and lesion size less than 2 cm at sonography (P = .043). No other imaging or clinical features were able to differentiate FA from phyllodes tumors. CONCLUSION CFEL with a larger size in older women is associated with the surgical pathological result of phyllodes tumor and management should be tailored accordingly. Younger patients with small size nodules might be approached less aggressively, depending on a personalized discussion with the surgeons, taking into account the results obtained in this study.
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Affiliation(s)
- Basma Al-Arnawoot
- Department of Diagnostic Imaging, Hamilton General Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Anabel Scaranelo
- Joint Department of Medical Imaging, Mount Sinai Hospital, Women's College Hospital, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Rachel Fleming
- Joint Department of Medical Imaging, Mount Sinai Hospital, Women's College Hospital, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Supriya Kulkarni
- Joint Department of Medical Imaging, Mount Sinai Hospital, Women's College Hospital, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Ravi J Menezes
- Joint Department of Medical Imaging, Mount Sinai Hospital, Women's College Hospital, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - David McCready
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Susan Done
- Laboratory Medicine Program, University Health Network-Toronto General Hospital Site, University of Toronto, Toronto, Ontario, Canada
| | - Vivianne Freitas
- Joint Department of Medical Imaging, Mount Sinai Hospital, Women's College Hospital, University of Toronto, University Health Network, Toronto, Ontario, Canada
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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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Sim Y, Lee SE, Kim EK, Kim S. A Radiomics Approach for the Classification of Fibroepithelial Lesions on Breast Ultrasonography. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:1133-1141. [PMID: 32102739 DOI: 10.1016/j.ultrasmedbio.2020.01.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/17/2020] [Accepted: 01/20/2020] [Indexed: 06/10/2023]
Abstract
A radiomics-based classifier to distinguish phyllodes tumor and fibroadenoma on gray-scale breast ultrasonography was developed and validated. A total of 93 radiomics features were extracted from representative transverse plane ultrasound images of 182 fibroepithelial lesions initially diagnosed by core needle biopsy. High-throughput radiomics features were selected using the intra-class correlation coefficient between two radiologist readers and the Least Absolute Shrinkage and Selection Operator regression through 10-fold cross-validation. When applied to the validation set, the radiomics classifier for the differentiation of phyllodes tumors and benign/fibroadenomas achieved an area under the receiver operating characteristic curve of 0.765 (95% confidence interval [CI]: 0.597-0.888) with an accuracy of 0.703 (sensitivity: 0.857; specificity: 0.5). Our radiomics signature-based classifier may help predict phyllodes tumors among fibroepithelial lesions on breast ultrasonography.
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Affiliation(s)
- Yongsik Sim
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Image Data Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Si Eun Lee
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Image Data Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun-Kyung Kim
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Image Data Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sungwon Kim
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Image Data Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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42
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Clark HR, Merchant KA, Omar LA, Compton LM, Hayes JC. Breast Lesions in Women Aged Younger than 30 Years: Clinical Presentation, Diagnosis, and Management. JOURNAL OF BREAST IMAGING 2020; 2:72-80. [PMID: 38425001 DOI: 10.1093/jbi/wbz086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/06/2019] [Indexed: 03/02/2024]
Abstract
Women aged younger than 30 years frequently present with palpable breast lesions, breast pain, and nipple discharge. Diagnostic work-up often results in benign findings, including a variety of benign solid masses, infectious or inflammatory conditions, pregnancy- or lactation-related abnormalities, and normal variants. While rare, breast cancer can occur within this demographic, and it is often more advanced and aggressive than in older women. Other rare tumors can present within this patient demographic, including primary sarcoma of the breast and granular cell tumors. A knowledge of the clinical presentation, diagnostic approach, and management of this spectrum of pathologic entities is crucial to ensure optimal and cost-effective care within this patient demographic.
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Affiliation(s)
- Haley R Clark
- The University of Texas Southwestern Medical Center, Department of Radiology, Dallas, TX
| | - Kanwal A Merchant
- The University of Texas Southwestern Medical Center, Department of Radiology, Dallas, TX
| | - Lena A Omar
- The University of Texas Southwestern Medical Center, Department of Radiology, Dallas, TX
| | - Lindsay M Compton
- The University of Texas Southwestern Medical Center, Department of Radiology, Dallas, TX
| | - Jody C Hayes
- The University of Texas Southwestern Medical Center, Department of Radiology, Dallas, TX
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43
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Hasdemir S, Tolunay Ş, Özşen M, Gökgöz MŞ. Phyllodes Tumor of the Breast: A Clinicopathological Evaluation of 55 Cases. Eur J Breast Health 2020; 16:32-38. [PMID: 31912011 PMCID: PMC6939715 DOI: 10.5152/ejbh.2019.4709] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/21/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Phyllodes tumors are biphasic tumors consisting of epithelial and stromal components that account for less than 1% of all breast tumors. According to the World Health Organization (WHO) phyllodes tumors are classified into three categories as benign, borderline and malignant. It has been reported that these tumors are usually benign and both the stromal component and the epithelial component may progress to malignancy. In this descriptive study, it was aimed to present the cases of phyllodes tumor and to evaluate the clinicopathological features of these tumors in the light of the literature. MATERIALS AND METHODS In our study, 55 cases of phyllodes tumor diagnosed between 2005-2018 in the Department of Medical Pathology were retrospectively studied. A total of 55 cases were included in the study. RESULTS All cases were female with a mean age of 39.7+15.2 years. Fifty-seven tumors diagnosed in 55 cases were classed as benign in 20 cases (35.1%), borderline in 14 cases (24.6%) and malignant phyllodes tumors in 23 cases (40.3%). Ductal carcinoma in situ (solid and cribriform type) were detected in one case with malignant phyllodes tumor, whereas invasive ductal carcinoma was detected in one case. Bilateral ductal carcinoma in situ was present in the patient with invasive ductal carcinoma. CONCLUSION These tumors which rapidly grow into large masses can be clinically and pathologically confused with benign lesions, macroscopic and microscopic evaluation of concomitant in situ-invasive carcinomas should be considered. Phyllodes tumors have an important role in breast surgery and pathology.
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Affiliation(s)
- Seçil Hasdemir
- Department of Pathology, Uludağ University School of Medicine, Bursa, Turkey
| | - Şahsine Tolunay
- Department of Pathology, Uludağ University School of Medicine, Bursa, Turkey
| | - Mine Özşen
- Department of Pathology, Uludağ University School of Medicine, Bursa, Turkey
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Mberu V, Macaskill EJ, Purdie C, Evans A. Preoperative prediction of margin requirement following a core biopsy result suggestive of a phyllodes tumour. Clin Radiol 2019; 75:319.e21-319.e27. [PMID: 31862110 DOI: 10.1016/j.crad.2019.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/13/2019] [Indexed: 10/25/2022]
Abstract
AIM To determine if imaging features of lesions with a core biopsy suggestive of a phyllodes tumour can be used to identify which lesions require surgical excision with margins. MATERIALS AND METHODS Thirty-one lesions were identified from a prospective database of ultrasound visible masses. Demographic, mammographic, and ultrasound features were assessed while blinded to surgical outcome. Features of those lesions requiring a margin and those that did not were compared. Statistical significance was established using the chi-square test and receiver operating characteristic (ROC) curves. RESULTS Thirteen lesions (42%) required a margin and 18 lesions (58%) did not. Features found significantly more frequently in those requiring a margin were a poorly defined margin on mammography (7/9 [78%] versus 4/13 [31%]; p=0.04) and at ultrasound, an irregular margin (8/13 [62%] versus 3/18 [17%]; p=0.01), micro-lobulations (7/13 [54%] versus 3/18 [17%]; p=0.028), mixed echogenicity (9/13 [69%] versus 1/18 [6%]; p=0.0002), echogenic clefts (6/13 [46%] versus 1/18 [6%]; p=0.007), posterior enhancement (9/11 [82%] versus 6/18 [33%]; p=0.01), large size (p=0.003) and stiffness at shear-wave elastography (p=0.026). All six screen-detected lesions were benign. CONCLUSIONS There are multiple preoperative features that can be used to guide surgical management of lesions with a preoperative core biopsy result suggestive of a phyllodes tumour.
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Affiliation(s)
- V Mberu
- Department of Breast Imaging, School of Medicine, University of Dundee, Ninewells Hospital & Medical School, Dundee, DD1 9SY, UK
| | - E J Macaskill
- Department of Breast Surgery, Ninewells Hospital, NHS Tayside, James Arrott Dr, Dundee, DD2 1SY, UK
| | - C Purdie
- Department of Pathology, Ninewells Hospital, NHS Tayside, James Arrott Dr, Dundee, DD2 1SY, UK
| | - A Evans
- Department of Breast Imaging, School of Medicine, University of Dundee, Ninewells Hospital & Medical School, Dundee, DD1 9SY, UK.
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Meng X, Yamanouchi K, Kuba S, Sakimura C, Morita M, Matsuguma K, Kanetaka K, Takatsuki M, Abe K, Eguchi S. Giant fibroadenoma of the breast: A rare case in a mature woman. Int J Surg Case Rep 2019; 63:36-39. [PMID: 31561187 PMCID: PMC6796725 DOI: 10.1016/j.ijscr.2019.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/31/2019] [Accepted: 09/09/2019] [Indexed: 11/16/2022] Open
Abstract
We experienced giant fibroadenoma of breast, a rare case in a mature woman. We suspected a malignant tumor, due to the size and ulceration and bleeding. Total mastectomy and skin grafting were needed for complete resection. An early diagnosis and treatment could prevent total mastectomy.
Introduction Fibroadenomas are common benign lesions of the breast that are usually found young patients. Giant fibroadenomas are uncommon benign lesions, defined as fibroadenomas of >5 cm in size, which are usually found in patients of less than 20 years of age. Presentation of case A 39-year-old premenopausal woman presented with a right breast tumor that had rapidly increased in size and which showed ulceration and bleeding. Needle biopsy showed mixed connective tissue and an epithelial tumor without a leaf-like pattern, but indeterminate. Total mastectomy and skin grafting were performed. Histopathology confirmed the diagnosis of giant fibroadenoma. Discussion In comparison to all previous reports on patients with giant fibroadenoma, this patient was relatively old and the etiology was unknown. Although rare, an appropriate therapeutic strategy should be decided according to the results of a histopathological examination. Conclusion Early treatment could allow breast preserving surgery and patients should be recommended to undergo reexamination with awareness of progression.
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Affiliation(s)
- Xiangyue Meng
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Kosho Yamanouchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
| | - Sayaka Kuba
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Chika Sakimura
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Michi Morita
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Kunihito Matsuguma
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Kengo Kanetaka
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Mitsuhisa Takatsuki
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Kuniko Abe
- Department of Pathology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan; Department of Pathology, Nagasaki Genbaku (Atomic Bomb) Hospital, 3-15 Mori-machi, Nagasaki, 852-8511, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
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Durhan G, Önder Ö, Azizova A, Karakaya J, Kösemehmetoğlu K, Akpınar MG, Demirkazık F. Can Radiologist and Pathologist Reach The Truth Together in The Diagnosis of Benign Fibroepithelial Lesions? Eur J Breast Health 2019; 15:176-182. [PMID: 31312794 DOI: 10.5152/ejbh.2019.4656] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/16/2019] [Indexed: 11/22/2022]
Abstract
Objective Benign fibroepithelial lesions (BFL) lesions of the breast are various and predominantly benign, although a few can be locally aggressive. Definitive diagnosis of some BFL can be challenging from core needle biopsy (CNB). Radiological findings can help guide the management of the lesions. The aim of this study was to investigate the accuracy rate of CNB results and evaluate the radiological findings of the most common BFL according to the final excision pathology results. The secondary aim was to assess the contribution of the imaging findings to CNB results. Materials and Methods A retrospective review was made of 266 patients diagnosed with suspicious BFL, conventional fibroadenoma, complex fibroadenoma, cellular fibroadenoma and benign phyllodes tumor (PT). The study included 132 patients who underwent surgical excision. The radiological and histopathological findings were evaluated. Results While 66 patients were diagnosed with more descriptive results on CNB, the other 66 patients were diagnosed with suspicious BFL. Agreement between CNB and excisional pathology was good, when CNB provided a definite diagnosis. While conventional and complex fibroadenoma were observed to have hypo or normal vascularity, cellular fibroadenoma and PT showed hypervascularity. Oval shaped and homogeneous internal echo pattern were significantly associated with conventional fibroadenoma. A heterogeneous internal echo pattern was seen in complex fibroadenomas and PT. Conclusion CNB often reaches the correct diagnosis alone when it gives a definite diagnosis. The radiological findings which help in the differentiation of BFL are hypervascularity, oval shape and internal heterogeneity. More accurate results can be obtained when histopathological and radiological findings are evaluated together.
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Affiliation(s)
- Gamze Durhan
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ömer Önder
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Aynur Azizova
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Jale Karakaya
- Department of Biostatistics, Hacettepe University School of Medicine, Ankara, Turkey
| | - Kemal Kösemehmetoğlu
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Turkey
| | | | - Figen Demirkazık
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
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Cui WJ, Wang C, Jia L, Ren S, Duan SF, Cui C, Chen X, Wang ZQ. Differentiation Between G1 and G2/G3 Phyllodes Tumors of Breast Using Mammography and Mammographic Texture Analysis. Front Oncol 2019; 9:433. [PMID: 31192133 PMCID: PMC6548862 DOI: 10.3389/fonc.2019.00433] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/07/2019] [Indexed: 01/22/2023] Open
Abstract
Purpose: To determine the potential of mammography (MG) and mammographic texture analysis in differentiation between Grade 1 (G1) and Grade 2/ Grade 3 (G2/G3) phyllodes tumors (PTs) of breast. Materials and methods: A total of 80 female patients with histologically proven PTs were included in this study. 45 subjects who underwent pretreatment MG from 2010 to 2017 were retrospectively analyzed, including 14 PTs G1 and 31 PTs G2/G3. Tumor size, shape, margin, density, homogeneity, presence of fat, or calcifications, a halo-sign as well as some indirect manifestations were evaluated. Texture analysis features were performed using commercial software. Receiver operating characteristic curve (ROC) was used to determine the sensitivity and specificity of prediction. Results: G2/G3 PTs showed a larger size (>4.0 cm) compared to PTs G1 (64.52 vs. 28.57%, p = 0.025). A strong lobulation or multinodular confluent was more common in G2/G3 PTs compared to PTs G1 (64.52 vs. 14.29%, p = 0.004). Significant differences were also observed in tumors' growth speed and clinical manifestations (p = 0.007, 0.022, respectively). Ten texture features showed significant differences between the two groups (p < 0.05), Correlation_AllDirection_offset7_SD and ClusterProminence_AllDirection_offset7_SD were independent risk factors. The area under the curve (AUC) of imaging-based diagnosis, texture analysis-based diagnosis and the combination of the two approaches were 0.805, 0.730, and 0.843 (90.3% sensitivity and 85.7% specificity). Conclusions: Texture analysis has great potential to improve the diagnostic efficacy of MG in differentiating PTs G1 from PTs G2/G3.
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Affiliation(s)
- Wen Jing Cui
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Cheng Wang
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.,Department of Graduate, Bengbu Medical College, Bengbu, China
| | - Ling Jia
- Sir Run Run Hospital, Nanjing Medical University, Nanjing, China
| | - Shuai Ren
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | | | - Can Cui
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiao Chen
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhong Qiu Wang
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
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Can whole-tumor apparent diffusion coefficient histogram analysis be helpful to evaluate breast phyllode tumor grades? Eur J Radiol 2019; 114:25-31. [DOI: 10.1016/j.ejrad.2019.02.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 02/12/2019] [Accepted: 02/26/2019] [Indexed: 12/20/2022]
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Cloete DJ, Minne C, Schoub PK, Becker JHR. Magnetic resonance imaging of fibroadenoma-like lesions and correlation with Breast Imaging-Reporting and Data System and Kaiser scoring system. SA J Radiol 2018; 22:1532. [PMID: 31754520 PMCID: PMC6837785 DOI: 10.4102/sajr.v22i2.1532] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 09/14/2018] [Indexed: 12/18/2022] Open
Abstract
Background Multiple breast lesions resembling fibroadenomas are a common imaging finding in patients presenting to the mammography unit at Dr George Mukhari Academic Hospital in the North-West district of Tshwane, South Africa. Patients often present with multiple lesions, up to 20 lesions per breast. These lesions often have atypical features on ultrasound and/or a clinical history of growth is commonly given. Phyllodes tumours may be indistinguishable from fibroadenomas and breast cancers may on occasion present with benign features, which can lead to misdiagnosis. Breast magnetic resonance imaging (bMRI) evaluation of lesions resembling fibroadenomas may improve accurate assessment and identification of lesions requiring biopsy. Objectives To assess the reliability of bMRI to characterise lesions resembling fibroadenomas on ultrasound, using the Breast Imaging-Reporting and Data System (BI-RADS) and Kaiser scoring systems with histopathological correlation. Method A quantitative, prospective, investigative study was performed with a sample size of 100 breast lesions among a total of 35 patients at Dr George Mukhari Academic Hospital. Patients were recruited after a breast ultrasound investigation revealed lesions resembling fibroadenomas, but with an indication for ultrasound-guided biopsy, for example, very large size, atypical features on ultrasound or a history of recent growth. The bMRI was performed prior to the ultrasound-guided breast biopsies. Three investigators independently evaluated the bMRI and applied BI-RADS descriptors to each lesion. The Kaiser score was then calculated for each lesion. Statistics were calculated using Pearson’s and Spearman’s coefficients for inter-reader variability, kappa scores for BI-RADS and Kaiser score correlation with histology. Results Evaluation with bMRI, BI-RADS and the Kaiser scoring system showed statistically significant correlation with each other and with histopathology results for each lesion. There was statistically significant agreement among the investigators regarding the interpretation of the lesions and allocation of appropriate BI-RADS scores. Conclusion Multiple lesions resembling fibroadenomas can be evaluated with bMRI when multiple breast biopsies would not be feasible. With a good imaging protocol and technique, adequate interpretation skills by the radiologist and the use of the Kaiser scoring system, an accurate diagnosis can be achieved.
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Affiliation(s)
- Daniel J Cloete
- Dr George Mukhari Academic Hospital, Ga-Rankuwa, South Africa.,Department of Diagnostic Radiology, Sefako Makgatho Health Sciences University, South Africa
| | - Cornelia Minne
- Dr George Mukhari Academic Hospital, Ga-Rankuwa, South Africa.,Department of Diagnostic Radiology, Sefako Makgatho Health Sciences University, South Africa
| | - Peter K Schoub
- Department of Radiology, Parklane Radiology, Johannesburg, South Africa
| | - Jan H R Becker
- Dr George Mukhari Academic Hospital, Ga-Rankuwa, South Africa.,Department of General Surgery, Sefako Makgatho Health Sciences University, South Africa
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Yii N, Read T, Tan CC, Ng SL, Bennett I. Diagnosing phyllodes tumours of the breast: how successful are our current preoperative assessment modalities? ANZ J Surg 2018; 88:988-992. [DOI: 10.1111/ans.14815] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/11/2018] [Accepted: 07/14/2018] [Indexed: 12/23/2022]
Affiliation(s)
- Nathan Yii
- Department of Surgery, Princess Alexandra Hospital; The University of Queensland; Brisbane Queensland Australia
| | - Tavis Read
- Department of Surgery, Princess Alexandra Hospital; The University of Queensland; Brisbane Queensland Australia
| | - Chuan Chien Tan
- Department of Surgery, Princess Alexandra Hospital; The University of Queensland; Brisbane Queensland Australia
| | - Suat Li Ng
- Department of Surgery, Princess Alexandra Hospital; The University of Queensland; Brisbane Queensland Australia
| | - Ian Bennett
- Department of Surgery, Princess Alexandra Hospital; The University of Queensland; Brisbane Queensland Australia
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