Diagnostic performance of core needle biopsy in identifying breast phyllodes tumors

Abstract

Background: A retrospective analysis of diagnoses was performed in patients with phyllodes tumors of the breast (PTB) who received preoperative core needle biopsy (CNB) and had breast surgery at Fudan University Shanghai Cancer Center from January 1, 2002 to April 1, 2013. The resulting data allowed us to compare the accordance between CNB and excision diagnoses of PTB patients and evaluate the accuracy of CNB in preoperative diagnosis. Methods:Data from 128 patients with PTB who had undergone preoperative CNB and breast surgery were retrospectively analyzed. We reviewed the medical history, clinical follow-up data, and CNB diagnostic data. A diagnostic test was used to evaluate the sensitivity and specificity of CNB in diagnosing benign, borderline, and malignant phyllodes tumors.Results: The accuracy of CNB for diagnosing PTB was 13.3% (17/128). Of the remaining patients, 98(75.5% of the PTB patients) were diagnosed with fibroadenoma or fibroepithelial lesions. The sensitivity of CNB at diagnosing benign, borderline, and malignant phyllodes tumors were 4.9% (2/41), 4.2% (3/71), and 25.0% (4/16), respectively, whereas the corresponding specificity were 92.0%, 98.2%, and 100%, respectively. Some clinical features, such as large tumor size, rapid growth, or surgical history of fibroadenomas, were indicative of an increased possibility of PTB.Conclusions: CNB provides a pathological basis for the preoperative diagnosis of PTB, but it has a poor accuracy and offers limited guidance for surgical decisions. Considering CNB along with multiple histologic features may improve the ability to accurately diagnose PTB. An integrated assessment using CNBs in combination with clinical data and imaging features is suggested as a reliable strategy to assist PTB diagnosis.

Core needle biopsy in fibroepithelial tumors: predicting factors for phyllodes tumors

“…It is also worth mentioning the difference in CNB accuracy in diagnosing benign, malignant, and borderline lesions. In 91 patients, Ward et al found a specificity of 57% for diagnosing benign PTs, 90% for borderline tumors, and 100% for malignant tumors ( 14 ).…”

Diagnosis on Excision Biopsy of Breast Tissues Labeled As Fibroepithelial Tumors on Trucut Samples in a Developing Country

“…These features are necessary to be considered for diagnosing the phyllodes as a marker of surgical excision. Zhou et al had described the sensitivity of core needle biopsy (CNB) at diagnosing benign, borderline, and malignant PTs as 4.9% (2/41), 4.2% (3/71), and 25.0% (4/16), respectively, that showed poor accuracy as a guide for surgical decisions if considered without these histological features (Figures 1-3) [15]. It is also worth mentioning that there is a difference in trucut biopsy accuracy in diagnosing benign, malignant, and borderline lesions.…”

Diagnosing phyllodes tumours of the breast: how successful are our current preoperative assessment modalities?

“…which retrospectively analysed phyllodes tumours detected in a BreastScreen Australia service, also highlighted the lack of specificity of mammography in identifying phyllodes tumours, with fine needle aspiration biopsy indicating the presence of a fibro‐epithelial lesion in only 21.7% of instances, and with core biopsy diagnosing or favouring phyllodes tumours in 62.5% of lesions. However, the sensitivity of core needle biopsy in diagnosing phyllodes tumours has varied greatly with some reports indicating a sensitivity as high as 83 % with other reports indicating an accuracy as low at 13.3% . It would appear that diagnostic sensitivity is improved by combining the radiological and the cytohistological results in a similar way to the triple assessment strategy used for other breast lesions.…”

“…However, the sensitivity of core needle biopsy in diagnosing phyllodes tumours has varied greatly with some reports indicating a sensitivity as high as 83% 10 with other reports indicating an accuracy as low at 13.3%. 21 It would appear that diagnostic sensitivity is improved by combining the radiological and the cytohistological results in a similar way to the triple assessment strategy used for other breast lesions. In a study by Ward et al, 22 the sensitivity of fine needle aspiration cytology, core needle biopsy and imaging for diagnosing phyllodes tumours was 40%, 63% and 65%, respectively, combining cytohistological and radiological tests improved sensitivity to 76%.…”