AI Article Synopsis
- Fibroepithelial lesions of the breast (FEL) include a range of tumors such as fibroadenomas and phyllodes tumors, which can be challenging to distinguish in core needle biopsies.
- A study of 305 patients from 2009 to 2019 found that 25.8% of cases upgraded to phyllodes tumors after excision, with factors like age over 50, larger size, and specific histological features increasing upgrade risk.
- The results suggest excising FEL is generally recommended, but monitoring smaller tumors may be a safe option for some patients.
Article Abstract
Introduction: Fibroepithelial lesions of the breast (FEL) are heterogeneous lesions ranging from fibroadenomas (FA) to phyllodes tumors (PT). FEL with cellular stroma are diagnostic challenges on core needle biopsy (CNB) as it is difficult to distinguish cellular FA from PT. The purpose of this study was to determine the features of FEL on CNB that may be predictive of PT, the upstage rate to PT after excision, and the outcomes of those who did not undergo excision.
Methods: Overall, 305 patients with FEL on CNB between 2009 and 2019 were identified from a prospectively maintained institutional database. Presentation, imaging, and pathology were evaluated.
Results: Mean age at diagnosis was 43.8 years. Pathology on CNB included 97 cases of FEL favoring FA, 19 cases of FEL favoring PT, 3 cases of FEL versus pseudoangiomatous stromal hyperplasia, and 186 cases of FEL not otherwise specified. Following CNB, 96 (31.5%) patients were observed, 158 (51.8%) patients had an excisional biopsy, 48 (15.7%) patients underwent segmental mastectomy, and 3 (1.0%) patients underwent a mastectomy. The upgrade rate from FEL on CNB to PT upon excision was 25.8%. PT on final pathology was more commonly seen when the CNB identified stromal overgrowth, necrosis, and diagnosis of FEL favoring PT. On multivariable analysis, a final diagnosis of PT was associated with age >50 years, larger tumor size >2 cm, stromal overgrowth, and ≥1 mitoses/10 high power fields (HPF) on CNB. Patients who were observed had smaller tumors compared with those who underwent excision.
Conclusion: In this 10-year single-institution experience of FEL, the upstage rate to PT was 25.8%. Excision of FEL is recommended. Furthermore, the observation of lesions appeared to be safe in select cases, specifically in patients with smaller tumor size.
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| http://dx.doi.org/10.1245/s10434-021-10931-0 | DOI Listing |
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Article Synopsis
- Fibroepithelial lesions of the breast (FEL) include a range of tumors such as fibroadenomas and phyllodes tumors, which can be challenging to distinguish in core needle biopsies.
- A study of 305 patients from 2009 to 2019 found that 25.8% of cases upgraded to phyllodes tumors after excision, with factors like age over 50, larger size, and specific histological features increasing upgrade risk.
- The results suggest excising FEL is generally recommended, but monitoring smaller tumors may be a safe option for some patients.
Core needle biopsy diagnosis of fibroepithelial lesions of the breast: a diagnostic challenge.
Pathology
October 2020
Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China. Electronic address:
Fibroepithelial lesions (FEL) of the breast are biphasic neoplasms consisting of proliferative epithelial and stromal components and include fibroadenoma, phyllodes tumour and periductal stromal tumour. Core needle biopsy (CNB) is a commonly used diagnostic modality for investigation of breast lesions. As the accurate diagnosis of FEL requires integrated assessment of both epithelial and stromal components, this may create problems in small biopsies with limited sampling.
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