Fibroepithelial breast lesions diagnosed by core needle biopsy demonstrate a moderate rate of upstaging to phyllodes tumors

Marcil, Gabriel; Wong, Stéphanie; Trabulsi, Nora; Allard-Coutu, Alexandra; Parsyan, Armen; Ömeroğlu, Atilla; Atinel, Gulbeyaz; Mesurolle, Benoı̂t; Meterissian, Sarkis

doi:10.1016/j.amjsurg.2016.12.017

Cited by 25 publications

(13 citation statements)

References 12 publications

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“…The overall upstage to PT in our study is 17.4% which is on the lower end of results in the literature for selective excision of FELs that ranges 18-42 % [4,[11][12][13]. However, when we stratify by the findings on CNB, those patients with FA have a risk of 7% but those with QPT have a risk of 36.6%.…”

Section: Discussioncontrasting

confidence: 57%

Excision of breast fibroepithelial lesions - when is it still necessary?: a 10-year review of a regional centre

Mousadoust¹,

Dingee²,

Chen³

et al. 2021

Preprint

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PurposeFibroepithelial lesions (FEL) range from benign fibroadenoma (FA) to malignant phyllodes tumor (PT), but can be difficult to diagnose on core needle biopsy (CNB). This study assesses risk factors for phyllodes tumor (PT) and recurrence and whether the policy to excise FELs over 3 cm in size is justified. MethodsPatients having surgery for FELs from 2009-2018 were identified. The association of clinical, radiology and pathological features with PT and recurrence were evaluated. Trend analysis was used to assess risk of PT based on imaging size. ResultsOf the 616 patients with FELs, 400 were identified as having FA on CNB and 216 were identified as having FEL with a comment of concern for phyllodes tumor (QPT). PT was identified in 107 cases, 28 had CNB of FA (7.0%) while 79 had QPT (36.6%). Follow-up was available for 86 with a mean of 56 months; 6 patients had recurrence of PT, all of whom had QPT on CNB. The finding of PT was associated with CNB of QPT, increasing age and size on multivariate logistic regression. All patients diagnosed with PT following CNB of FA had enlarging lesions with a mean size of 38.3 mm. ConclusionsOur data does not support routine excision of FELs at 3 cm. Patients with QPT on CNB should consider excision due to high risk of PT and recurrence and the decision to excise FAs to rule out PT should also consider whether the lesion is enlarging.

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Section: Discussioncontrasting

confidence: 57%

Excision of breast fibroepithelial lesions - when is it still necessary?: a 10-year review of a regional centre

Mousadoust¹,

Dingee²,

Chen³

et al. 2021

Preprint

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“…PTs and FAs account for most cases of fibroepithelial lesions. Differentiating between benign PT and FA is still a challenge clinically and histologically [ 11 ]. When the tumor is fast-growing, histological examination is necessary to exclude benign PT.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided vacuum-assisted excisional biopsy to treat benign phyllodes tumors

Shang

Zhang

et al. 2020

The Breast

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Purpose To evaluate the value of ultrasound (US)-guided vacuum-assisted excisional biopsy (VAB) in treating benign phyllodes tumors (PTs) of the breasts and to investigate the lesion characteristics that could affect the local recurrence rate. Patient and methods From December 2008 to February 2018, 93 patients with PTs diagnosed on histology underwent US-guided, 7-gauge VAB. The recurrence rate of benign PT and complications of VAB were evaluated on follow-up US every three to six months. The lesion characteristics were analyzed to identify the factors affecting the recurrence rate. Results Of the 87 patients, local recurrence was found in 15 patients (17%) in a mean follow-up period of 35.8 months, and the rate of complete excision was 82.8% (72/87). PTs with a largest diameter less than 3.3 cm had a significantly lower recurrence rate than PTs with a largest diameter larger than 3.3 cm (P < 0.05). Conclusions In conclusion, US-guided VAB is an effective method to treat benign PT, especially in lesions with a diameter less than 3.3 cm.

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“…Since BPTs progressively enlarge and have a risk of borderline or malignant transformation, the treatment option is surgery with negative surgical margins because of the high risk of local recurrence . However, for the clinical management of SFAs, radiologic follow‐up is conservative, and no surgical excision is recommended for stable lesions …”

mentioning

confidence: 99%

Texture Analysis of Ultrasound Images to Differentiate Simple Fibroadenomas From Complex Fibroadenomas and Benign Phyllodes Tumors

Akin

Özgül

Şimşek

et al. 2020

J of Ultrasound Medicine

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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 borderlinemalignant 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 benignmalignant 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. Firstand 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, GLCMentropy 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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Fibroepithelial breast lesions diagnosed by core needle biopsy demonstrate a moderate rate of upstaging to phyllodes tumors

Cited by 25 publications

References 12 publications

Excision of breast fibroepithelial lesions - when is it still necessary?: a 10-year review of a regional centre

Excision of breast fibroepithelial lesions - when is it still necessary?: a 10-year review of a regional centre

Ultrasound-guided vacuum-assisted excisional biopsy to treat benign phyllodes tumors

Texture Analysis of Ultrasound Images to Differentiate Simple Fibroadenomas From Complex Fibroadenomas and Benign Phyllodes Tumors

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