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

Reis, Yedda Nunes; Maesaka, Jonathan Yugo; Shimizu, Carlos; Soares-Júnior, José Maria; Baracat, Edmund Chada; Filassi, José Roberto

doi:10.6061/clinics/2021/e2806

Cited by 3 publications

(4 citation statements)

References 15 publications

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“…In a study by Reis et al, they found that fibroepithelial tumors diagnosed after the trucut biopsy, but having a larger size of more than 30 mm on ultrasound, have a greater probability of being pre-malignant. So, fibroepithelial lesions larger than 30 cm are more likely to be PT and are coherent with the existing medical literature [2]. Significant predictors of increased risk of PT were patient age equal to or greater than 50 years (P = 0.021) and lesion size more than 30 mm at sonography [14].…”

Section: Discussionsupporting

confidence: 83%

“…In women, breast cancer is the most common of all tumors [1]. Breast fibroepithelial tumors are a type of biphasic neoplasm that fallouts from the development of both stromal and epithelial components, and include cellular fibroadenoma (FA), FA with cellular stroma, fibroepithelial lesion with cellular stroma, phyllodes tumor (PT), or cyst sarcoma phyllodes [2] They are prevalent in young women and middle-aged women's and are allied to increase the incidence of malignant transformation in many instances [3].…”

Section: Introductionmentioning

confidence: 99%

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

Latif¹,

Loya²,

Hameed³

et al. 2021

Cureus

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Introduction: Fibroadenomas (FAs) and phyllodes tumors (PTs) are less prevalent but allied to have malignant transformation in many instances. It is a challenge to diagnose the phyllodes by conventional trucut biopsy technique.Objective: To evaluate the histological characteristics of tumors labeled as fibroepithelial lesions of breast tissues on trucut biopsy and compare with a diagnosis on excision biopsy. Methods and materials: It was a descriptive cross-sectional study that was carried out in Shaukat Khanum Memorial Hospital and Research Centre within six years from January 2015 to January 2021. In trucut samples, stromal cellularity, stromal cell nuclear atypia, mitotic count, stromal overgrowth, the enhancement of stromal cellularity adjacent to epithelium were scrutinized. In each category, the activity was seen as absent, mild, moderate, or severe. Mitotic activity was graded as 0-1, 0-5, 5-10, >10.Results: A total of 125 patients were registered for the study. The mean age of patients in our study was 33.86 ± 9.95 years. The mean size was 41.02 ± 27.38 mm with a mean lump duration of 7.52 ± 5.34 months. In the FA group, the trucut sampling report showed the stromal cellularity as mild in 62 (69.7%) and stromal cell nuclear atypia as absent in 68 (76.4%) cases. But in the phyllodes tumor group, the stromal cellularity was severe in 10 (27.8%) patients and stromal cell nuclear atypia was severe in five (13.9%). The ultimate outcome showed that 89 (71.2%) patients had FA and 36 (28.8%) had PT at excision. Conclusion:Assessment of tumor size, stromal cellularity, mitoses, and enhancement of stromal cellularity adjacent to epithelium are useful markers for diagnosing the PT in trucut needle biopsy.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

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

Latif¹,

Loya²,

Hameed³

et al. 2021

Cureus

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“…European guidelines, however, endorse the use of the term "benign fibroepithelial tumor, B3" in needle biopsies if no definitive diagnosis can be made. The majority of PT is benign, whereas borderline and malignant PT occur less frequently [75].…”

Section: Histological Featuresmentioning

confidence: 99%

Third International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions)

Elfgen,

Leo,

Kubik-Huch

et al. 2023

Virchows Arch

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The heterogeneous group of B3 lesions in the breast harbors lesions with different malignant potential and progression risk. As several studies about B3 lesions have been published since the last Consensus in 2018, the 3rd International Consensus Conference discussed the six most relevant B3 lesions (atypical ductal hyperplasia (ADH), flat epithelial atypia (FEA), classical lobular neoplasia (LN), radial scar (RS), papillary lesions (PL) without atypia, and phyllodes tumors (PT)) and made recommendations for diagnostic and therapeutic approaches. Following a presentation of current data of each B3 lesion, the international and interdisciplinary panel of 33 specialists and key opinion leaders voted on the recommendations for further management after core-needle biopsy (CNB) and vacuum-assisted biopsy (VAB). In case of B3 lesion diagnosis on CNB, OE was recommended in ADH and PT, whereas in the other B3 lesions, vacuum-assisted excision was considered an equivalent alternative to OE. In ADH, most panelists (76%) recommended an open excision (OE) after diagnosis on VAB, whereas observation after a complete VAB-removal on imaging was accepted by 34%. In LN, the majority of the panel (90%) preferred observation following complete VAB-removal. Results were similar in RS (82%), PL (100%), and FEA (100%). In benign PT, a slim majority (55%) also recommended an observation after a complete VAB-removal. VAB with subsequent active surveillance can replace an open surgical intervention for most B3 lesions (RS, FEA, PL, PT, and LN). Compared to previous recommendations, there is an increasing trend to a de-escalating strategy in classical LN. Due to the higher risk of upgrade into malignancy, OE remains the preferred approach after the diagnosis of ADH.

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“…While some of the current clinical management may be attributed to concern about more advanced disease in the absence of strong data, there may be an educational gap regarding current guidelines and appropriate practice. However it is notably difficult to obtain a correct pre-operative diagnosis from biopsy material [ 34 ], not least regarding stage (benign/borderline/malignant) and that fact might influence clinicians to advocate wider excisions in order to err on the side of caution. We suggest empirical consensus guidelines to be crafted, inspired by our findings and grounded in the currently available evidence.…”

Section: Discussionmentioning

confidence: 99%

Current clinical practice in the management of phyllodes tumors of the breast: an international cross-sectional study among surgeons and oncologists

Sars

Sackey

Frisell

et al. 2023

Breast Cancer Res Treat

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Purpose Phyllodes tumors of the breast are rare fibroepithelial lesions that are classified as benign, borderline or malignant. There is little consensus on best practice for the work-up, management, and follow-up of patients with phyllodes tumors of the breast, and evidence-based guidelines are lacking. Methods We conducted a cross-sectional survey of surgeons and oncologists with the aim to describe current clinical practice in the management of phyllodes tumors. The survey was constructed in REDCap and distributed between July 2021 and February 2022 through international collaborators in sixteen countries across four continents. Results A total of 419 responses were collected and analyzed. The majority of respondents were experienced and worked in a university hospital. Most agreed to recommend a tumor-free excision margin for benign tumors, increasing margins for borderline and malignant tumors. The multidisciplinary team meeting plays a major role in the treatment plan and follow-up. The vast majority did not consider axillary surgery. There were mixed opinions on adjuvant treatment, with a trend towards more liberal regiments in patients with locally advanced tumors. Most respondents preferred a five-year follow-up period for all phyllodes tumor types. Conclusions This study shows considerable variation in clinical practice managing phyllodes tumors. This suggests the potential for overtreatment of many patients and the need for education and further research targeting appropriate surgical margins, follow-up time and a multidisciplinary approach. There is a need to develop guidelines that recognize the heterogeneity of phyllodes tumors.

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

Cited by 3 publications

References 15 publications

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

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

Third International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions)

Current clinical practice in the management of phyllodes tumors of the breast: an international cross-sectional study among surgeons and oncologists

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