Determining Whether Excision of All Fibroepithelial Lesions of the Breast Is Needed to Exclude Phyllodes Tumor

Abstract

Fibroepithelial lesions (FELs) are a common histologic finding on core needle biopsy (CNB) of the breast. Fibroepithelial lesions include fibroadenoma and phyllodes tumor, which can be difficult to distinguish with an initial CNB. An institutional experience was reviewed from February 12, 2001, to January 4, 2007, to determine the safety of selective rather than routine excision of FELs and to determine the factors associated with upgrading diagnosis of FELs to phyllodes tumors without definitive phyllodes tumor diagnosis by CNB. Of 313 patients, 261 (83%) with FELs diagnosed by CNB received observation with long-term follow-up (mean, 8 years). Of the observed patients, 3 (1%) were diagnosed with phyllodes tumor on follow-up. Eighteen of 52 patients (35%) who received excision had an upgrade of diagnosis to phyllodes tumor. Sensitivity and specificity of the pathologist's comment of concern for phyllodes tumor on a CNB demonstrating FELs without definitive phyllodes tumor diagnosis were 82% and 93%, respectively. Our policy of selective excision of FELs without definitive phyllodes tumor diagnosis resulted in safe avoidance of many surgical procedures.

Phyllodes tumour of the breast and margins: How much is enough?

“…The data available in literature on Phyllodes tumours include retrospective reviews and large, single-centre studies. [5][6][7][8][9] The following points summarize what these studies tell us about the management of Phyllodes tumours: • Prognosis is excellent for Phyllodes tumours following surgical excision, with no requirement for adjuvant therapy. 5,6 • As long as the microscopic surgical margins are free of disease, the extent of surgery does not correlate with disease-free survival or local recurrence.…”

“…5 • The upgrade rate of fibroepithelial lesions to Phyllodes tumours following a period of observation is low. 9 We performed a retrospective review at our single tertiary referral centre of all patients who had undergone surgical therapy for Phyllodes Phyllodes breast tumours are fairly uncommon, and they can be benign, borderline or malignant. General surgeons usually encounter them following the surgical excision of a breast lump that had the appearance of a fibroepithelial lesion.…”

Is excision biopsy of fibroadenomas based solely on size criteria warranted?

“…However, excision of such lesions—be it via open excision or vacuum‐assisted core needle biopsy—is not without risk including surgical or anesthetic complications, tissue distortion with unsatisfactory cosmetic result, and potential placement of unnecessary burden on limited health service resources. Large series have concluded that FA diagnosed by core needle biopsy with imaging pathologic concordance can usually be safely managed without further intervention and have advocated an individual case‐based approach toward management . Conversely, the potential of increasing morbidity and mortality with delayed diagnosis of higher grade disease is potentially catastrophic.…”

“…At present, despite many useful histologic pointers, there are no absolutely determinative features to distinguish between FA and benign PT on CNB resulting in a high number of excisions to outrule this lesion . The distinction between FA and PT in particular malignant PT is clinically important.…”

Pathologic Upgrade Rates of High-Risk Breast Lesions on Digital Two-Dimensional vs Tomosynthesis Mammography

“…In a recent study of 313 biphasic neoplasms on core needle biopsy, only 1 (0.3%) was upgraded to malignant phyllodes at surgical excision. 38 Of the 59 patients with biphasic neoplasms who opted for surgical excision in our study cohort, 18 (30.5%) were found to have low-grade phyllodes tumors. These results are also similar to other studies, which have reported low-grade phyllodes tumor in 18.8% of 213 surgically excised lesions 39 and 30.2% of 43 surgically excised lesions.…”