1
|
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.
Collapse
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
| |
Collapse
|
2
|
Li X, Vail E, Maluf H, Chaum M, Leong M, Lownik J, Che M, Giuliano A, Cao D, Dadmanesh F. Gene Expression Profiling of Fibroepithelial Lesions of the Breast. Int J Mol Sci 2023; 24:ijms24109041. [PMID: 37240386 DOI: 10.3390/ijms24109041] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
Fibroepithelial lesions of the breast (FELs) are a heterogeneous group of neoplasms exhibiting a histologic spectrum ranging from fibroadenomas (FAs) to malignant phyllodes tumors (PTs). Despite published histologic criteria for their classification, it is common for such lesions to exhibit overlapping features, leading to subjective interpretation and interobserver disagreements in histologic diagnosis. Therefore, there is a need for a more objective diagnostic modality to aid in the accurate classification of these lesions and to guide appropriate clinical management. In this study, the expression of 750 tumor-related genes was measured in a cohort of 34 FELs (5 FAs, 9 cellular FAs, 9 benign PTs, 7 borderline PTs, and 4 malignant PTs). Differentially expressed gene analysis, gene set analysis, pathway analysis, and cell type analysis were performed. Genes involved in matrix remodeling and metastasis (e.g., MMP9, SPP1, COL11A1), angiogenesis (VEGFA, ITGAV, NFIL3, FDFR1, CCND2), hypoxia (ENO1, HK1, CYBB, HK2), metabolic stress (e.g., UBE2C, CDKN2A, FBP1), cell proliferation (e.g., CENPF, CCNB1), and the PI3K-Akt pathway (e.g., ITGB3, NRAS) were highly expressed in malignant PTs and less expressed in borderline PTs, benign PTs, cellular FAs, and FAs. The overall gene expression profiles of benign PTs, cellular FAs, and FAs were very similar. Although a slight difference was observed between borderline and benign PTs, a higher degree of difference was observed between borderline and malignant PTs. Additionally, the macrophage cell abundance scores and CCL5 were significantly higher in malignant PTs compared with all other groups. Our results suggest that the gene-expression-profiling-based approach could lead to further stratification of FELs and may provide clinically useful biological and pathophysiological information to improve the existing histologic diagnostic algorithm.
Collapse
Affiliation(s)
- Xiaomo Li
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Eric Vail
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Horacio Maluf
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Manita Chaum
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Matthew Leong
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Joseph Lownik
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Mingtian Che
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Armando Giuliano
- Saul and Joyce Brandman Breast Center, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Duoyao Cao
- Department of Biomedical Science, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Farnaz Dadmanesh
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| |
Collapse
|
3
|
A Rare Case of the Malignant Phyllodes Breast Tumor - Case Report. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2022. [DOI: 10.2478/sjecr-2022-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
The phyllodes tumor (cystosarcoma phyllodes) is a rare fibroepithelial neoplasm presenting less than 1% of all breast tumors. Based on histologic features World Health Organization (WHO) classifies into benign, border line and malignant tumors (the rarest). Only around 5-15% of all malignant form cases metastasize hematogeneosly in the lung, bone and brain. Clinically are mostly presented the phyllodes tumor mostly presents as a rapid growth, palpabile, painless, elastic, oval or lobulated masses over 5 cm among women between 40 to 50 years old. On ultrasound and mammography these tumors usually resembles other round or oval benign lesions, mostly like fibroadenomas. These tumors on ultrasound and mammography usually resembles other round or oval benign tumors, mostly like fibroadenomas. Ultrasound guided core needle biopsiy (CNB) performed under ultrasound is a gold standard for palpabile breast masses. Surgical resection remains the gold standard of treatment. To date, there is no consensus regarding the recommendations for radiotherapy, hormonal therapy and systemic chemotherapy. We present the case of 30 years old woman, who noted a painless mass in her left breast, which was gradually increasing in size. Clinical, ultrasound and magnetic resonance examination confirmed the existence of tumor formation without the possibility of making an accurate diagnosis. Malignant phyllodes tumor was initially diagnosed by core biopsy. The patient underwent a radical modified mastectomy and postoperative radiotherapy. During the follow-up for the first 11 months, our patient has been feeling well without signs of local recurrence and metastasis. The aim of our case is to emphasize the importance of early diagnosis and treatment of this rare breast tumor.
Treatment is based on the size and the extent of the mass with surgical resection and adequate margins extremely important in successful outcome. We present the case of 30 old woman, who noted a painless mass in her left breast, which was gradually increasing in size. She was diagnosed with ultrasound and magnetic resonance imaging and the diagnosis of the malignant phyllodes tumor was confirmed by patohistological verification.
Collapse
|
4
|
Zhao L, Komforti MK, Dawson A, Rowe JJ. Periductal Stromal Tumor of the Breast: One Institution's Review of 6 Tumors Over a 22 Year Period With Immunohistochemical Analysis. Int J Surg Pathol 2022; 30:370-377. [PMID: 34821169 DOI: 10.1177/10668969211060482] [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: 11/16/2022]
Abstract
Introduction. Periductal stromal tumor (PST) of the breast is a rare fibroepithelial neoplasm with controversial pathogenesis. Methods. A retrospective search of our Pathology database from 2000 to 2021 identified 6 PST, all evaluated according to the Armed Forces Institute of Pathology (AFIP) criteria. Immunohistochemistry for CD10, CD34, KIT, GATA3, p63, SOX10, ER, PR, HER2, smooth muscle actin (SMA), beta-catenin, and myogenin was performed as well. Results. All 6 patients were female and age ranged from 29 to 55 years (mean 40 years). Tumor size ranged from 2.9 to 5.9 cm (mean 3.0 cm). Data showed absence of leaf-like architecture (0/6), at least moderate hypercellularity (6/6), lack of a circumscribed border (5/6), coalescing nodules with intermixed adipose tissue (4/6), at least moderate stromal atypia (4/6), and an elevated mitotic activity ≥3mitotic figures/10 HPF (6/6). The stromal cells were positive for CD10 (4/4), CD34 (4/4), KIT (3/4), and SMA (3/4), and negative for GATA3 (0/6), p63 (0/6), SOX10 (0/6), ER (0/4), PR (0/4), HER2 (0/4), nuclear beta-catenin (0/5), and myogenin (0/4). No patient had a PST recurrence or metastasis (average follow-up of 91 months). Conclusion. We confirm that PST shares morphologic and immunophenotypic similarities with phyllodes tumor (PT). However, PST can be reliably differentiated from PT using the AFIP criteria. Additionally, PST's immunoprofile of positive KIT and CD34 stromal expression alongside the negative GATA3, p63, and SOX10 reactivity can aid the pathologist in excluding metaplastic carcinoma. All 6 of our PST behaved as benign neoplasms akin to benign PT.
Collapse
|