Correlation between fibroepithelial lesions with breast core needle biopsy and surgical excision
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Abstract
Fibroepithelial lesions (FELs) are well known as the most commonly found in breast pathology that can be diagnosed by core needle biopsy (CNB). FELs consist of fibroadenoma (FA) lesions and phyllodes tumor (PT). FELs have overlapping histological characteristics thereby complicating the distinction between FA and PT with an initial CNB. Therefore, our study aimed to differentiate the histological characteristics of FELs on CNB, and whether there was a correlation with an upgrade of diagnosis of PT on subsequent excisional specimens. A retrospective review of all FELs diagnosed by CNB in FELs identified patients at Khon Kaen University (Srinagarind Hospital) during six years (2013-2018) was conducted by three pathologists to confirm the diagnosis of the features of CNB and subsequent excisional specimens. Of 209 patients who were diagnosed with FELs by CNB, 76 cases received subsequent excision. The excisional specimens were reviewed for FA (52 of 76), and whether they were benign PT (16 of 76) or borderline PT (8 of 76). No malignant PT was identified in our study. Overall stromal cellularity (moderate and high degrees, 58.3 and 20.8 %; p< 0.001), stromal pleomorphism (moderate and high atypia, 66.7 and 4.2%; p< 0.001), and stromal overgrowth at 100x (87.5%; p<0.001) on CNB correlated markedly with an upgrade of PT diagnosis on subsequent excisional specimens. Our study provided evidence for the differentiation of FELs features on associated CNB with an upgrade PT diagnosis on subsequent excisional specimens. Hence, FELs diagnosed by CNB can be used for excision with a clear margin in the future.
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References
Yang X, Kandil D, Cosar EF, Khan A. Fibroepithelial tumors of the breast: pathologic and immunohistochemical features and molecular mechanisms. Arch Pathol Lab Med. 2014;138(1):25-36.
Pandey M, Mathew A, Kattoor J, Abraham EK, Mathew BS, Rajan B, et al. Malignant phyllodes tumor. Breast J. 2001;7(6):411-416.
Tan BY, Acs G, Apple SK, Badve S, Bleiweiss IJ, Brogi E, et al. Phyllodes tumours of the breast: a consensus review. Histopathology. 2016;68(1):5-21.
Parker SJ, Harries SA. Phyllodes tumours. Postgrad Med J. 2001;77(909):428-435.
Parker SH, Burbank F, Jackman RJ, Aucreman CJ, Cardenosa G, Cink TM, et al. Percutaneous large-core breast biopsy: a multi-institutional study. Radiology. 1994;193(2):359-364.
Tsang AK, Chan SK, Lam CC, Lui PC, Chau HH, Tan PH, et al. Phyllodes tumours of the breast - differentiating features in core needle biopsy. Histopathology. 2011;59(4):600-608.
Krings G, Bean GR, Chen YY. Fibroepithelial lesions; the WHO spectrum. Semin Diagn Pathol. 2017;34(5):438-452.
Abdulcadir D, Nori J, Meattini I, Giannotti E, Beori C, Vanzi, E, et al. Phyllodes tumours of the breast diagnosed as B3 category on image-guided 14-gauge core biopsy: analysis of 51 cases from a single institution and review of the literature. Eur J Surg Oncol. 2014;40(7):859-864.
Burbank F. Stereotactic breast biopsy of atypical ductal hyperplasia and ductal carcinoma in situ lesions: improved accuracy with directional, vacuum-assisted biopsy. Radiology. 1997;202(3):843-847.
Pinder SE, Shaaban A, Deb R, Desai A, Gandhi A, Lee AHS, et al. NHS breast screening multidisciplinary working group guidelines for the diagnosis and management of breast lesions of uncertain malignant potential on core biopsy (B3 lesions). Clin Radiol. 2018;73(8):682-692.
Zhang Y, Kleer CG. Phyllodes tumor of the breast: histopathologic features, differential diagnosis, and molecular/genetic updates. Arch Pathol Lab Med. 2016;140(7):665-671.
Tan BY, Tan PH. A diagnostic approach to fibroepithelial breast lesions. Surg Pathol Clin. 2018; 11(1):17-42.
Li JJX, Tse GM. Core needle biopsy diagnosis of fibroepithelial lesions of the breast: a diagnostic challenge. Pathology. 2020;52(6):627-634.
Morgan JM, Douglas JAG, Gupta SK. Analysis of histological features in needle core biopsy of breast useful in preoperative distinction between fibroadenoma and phyllodes tumour. Histopathology. 2010;56(4):489-500.
Jung J, Kang E, Chae SM, Kim H, Park SY, Yun B. Development of a management algorithm for the diagnosis of cellular fibroepithelial lesions from core needle biopsies. Int J Surg Pathol. 2018;26(8):684-692.
Lee AH, Hodi Z, Ellis IO, Elston CW. Histological features useful in the distinction of phyllodes tumour and fibroadenoma on needle core biopsy of the breast. Histopathology. 2007;51(3):336-344.
Bode MK, Rissanen T, Apaja SM. Ultrasonography and core needle biopsy in the differential diagnosis of fibroadenoma and tumor phyllodes. Acta Radiol. 2007;48(7):708-713.
Ward ST, Jewkes AJ, Jones BG, Chaudhri S, Hejmadi RK, Ismail T, et al. The sensitivity of needle core biopsy in combination with other investigations for the diagnosis of phyllodes tumours of the breast. Int J Surg. 2012;10(9):527-531.
Yasir S, Gamez R, Jenkins S. Visscher DW, Nassar A. Significant histologic features differentiating cellular fibroadenoma from phyllodes tumor on core needle biopsy specimens. Am J Clin Pathol. 2014;142(3):362-369.
Osdol VAD, Landercasper J, Andersen JJ, Ellis RL, Gensch EM, Johnson JM, et al. Determining whether excision of all fibroepithelial lesions of the breast is needed to exclude phyllodes tumor: upgrade rate of fibroepithelial lesions of the breast to phyllodes tumor. JAMA Surg. 2014;149(10):1081-1085.
Neville G, Neill CO, Murphy R, Corrigan M, Redmond PH, Feeley L, et al. Is excision biopsy of fibroadenomas based solely on size criteria warranted? Breast J. 2018;24(6):981-985.
Limberg J, Barker K, Hoda S, Simmons R, Michaels A, Marti JL. Fibroepithelial lesions (FELs) of the breast: is routine excision always necessary? World J Surg. 2020;44(5):1552-1558.
Choi J, Koo JS. Comparative study of histological features between core needle biopsy and surgical excision in phyllodes tumor. Pathol Int. 2012;62(2):120-126.
Corben AD, Edelweiss M, Brogi E. Challenges in the interpretation of breast core biopsies. Breast J. 2010;16 Suppl 1:S5-S9.
Kim GR, Choi JS, Han BK, Ko EY, Ko ES, Hahn SY. Combination of shear-wave elastography and color doppler: feasible method to avoid unnecessary breast excision of fibroepithelial lesions diagnosed by core needle biopsy. PLoS One. 2017;12(5):e0175380.
Rizzo M, Linebarger J, Lowe MC, Pan L, Gabram SG, Vasquez, et al. Management of papillary breast lesions diagnosed on core-needle biopsy: clinical pathologic and radiologic analysis of 276 cases with surgical follow-up. J Am Coll Surg. 2012;214(3):280-287.
Arnawoot AB, Scaranelo A, Fleming R, Kulkarni S, Menezes RJ, McCready D, et al. Cellular fibroepithelial lesions diagnosed on core needle biopsy: Is there any role of clinical-sonography features helping to differentiate fibroadenomas and phyllodes tumor? J Surg Oncol. 2020;122(3):382-387.
Marcil G, Wong S, Trabulsi N, Coutu AA, Parsyan A, Omeroglu A, et al. Fibroepithelial breast lesions diagnosed by core needle biopsy demonstrate a moderate rate of upstaging to phyllodes tumors. Am J Surg. 2017;214(2):318-322.
Lazaro JAR, Akhilesh M, Thike AA, Lui PC, Tse GM, Tan PH. Predictors of phyllodes tumours on core biopsy specimens of fibroepithelial neoplasms. Histopathology. 2010;57(2):220-232.