Accuracy and clinical implications of pre-operative breast core needle biopsy diagnoses of fibroepithelial neoplasms and sarcomatoid carcinomas

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Abstract

Purpose: Accurate classification of breast phyllodes tumors (PTs) on core biopsy can be challenging. The differential diagnosis of benign PT (BP) is fibroadenoma (FA), whereas the differential diagnosis of malignant PT (MP) is sarcomatoid (metaplastic) carcinoma (SC). Methods: Here, we compare the pre-excision core biopsy diagnosis and clinicopathologic features of histologically confirmed MP, borderline PT (BLP), BP, FA, and SC. Consecutive cases of 34 histologically confirmed PT (14 MP, 10 BLP, 10 BP), 13 SC, and 10 FA were identified. Results: A core biopsy diagnosis of SC was made only in SC (77%, p = 0.003). The diagnosis “malignant neoplasm” or “atypical spindle cell neoplasm” was made in 100% MP and 23% SC, but no other tumor (p = 0.0001). The diagnosis “phyllodes tumor” was made only in PT (44% BLP, 11% BP, p = 0.06). The diagnosis “fibroepithelial lesion” was made in 44% BLP, 67% BP, and 29% FA. The diagnosis “FA” was made most commonly in FA (57%) (versus 22% BP and no other tumor; p = 0.002). Neoadjuvant therapy was given only in SC (23%, p = 0.03); adjuvant therapy was given in 46% SC and 13% MP (p = 0.04). Conclusions: A pre-operative core biopsy diagnosis of “malignant spindle cell neoplasm” separates MP and SC from BLP, BP, and FA. However, MP and SC can have overlapping features on core biopsy. Thus, one must be careful not to overcall SC on core biopsy, as patients diagnosed with SC may receive neoadjuvant therapy. A core biopsy diagnosis of “phyllodes tumor” is specific for PT and can guide treatment planning of a wide local excision.

Original languageEnglish (US)
JournalBreast Cancer Research and Treatment
DOIs
StatePublished - Jan 1 2019

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Fibroepithelial Neoplasms
Large-Core Needle Biopsy
Breast
Fibroadenoma
Carcinoma
Biopsy
Phyllodes Tumor
Neoplasms
Neoadjuvant Therapy
Differential Diagnosis

Keywords

  • Core biopsy
  • Fibroepithelial lesion
  • Malignant phyllodes tumor
  • Phyllodes tumor
  • Sarcomatoid carcinoma

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

@article{63e877ad12154359aac3955fae0bdfd0,
title = "Accuracy and clinical implications of pre-operative breast core needle biopsy diagnoses of fibroepithelial neoplasms and sarcomatoid carcinomas",
abstract = "Purpose: Accurate classification of breast phyllodes tumors (PTs) on core biopsy can be challenging. The differential diagnosis of benign PT (BP) is fibroadenoma (FA), whereas the differential diagnosis of malignant PT (MP) is sarcomatoid (metaplastic) carcinoma (SC). Methods: Here, we compare the pre-excision core biopsy diagnosis and clinicopathologic features of histologically confirmed MP, borderline PT (BLP), BP, FA, and SC. Consecutive cases of 34 histologically confirmed PT (14 MP, 10 BLP, 10 BP), 13 SC, and 10 FA were identified. Results: A core biopsy diagnosis of SC was made only in SC (77{\%}, p = 0.003). The diagnosis “malignant neoplasm” or “atypical spindle cell neoplasm” was made in 100{\%} MP and 23{\%} SC, but no other tumor (p = 0.0001). The diagnosis “phyllodes tumor” was made only in PT (44{\%} BLP, 11{\%} BP, p = 0.06). The diagnosis “fibroepithelial lesion” was made in 44{\%} BLP, 67{\%} BP, and 29{\%} FA. The diagnosis “FA” was made most commonly in FA (57{\%}) (versus 22{\%} BP and no other tumor; p = 0.002). Neoadjuvant therapy was given only in SC (23{\%}, p = 0.03); adjuvant therapy was given in 46{\%} SC and 13{\%} MP (p = 0.04). Conclusions: A pre-operative core biopsy diagnosis of “malignant spindle cell neoplasm” separates MP and SC from BLP, BP, and FA. However, MP and SC can have overlapping features on core biopsy. Thus, one must be careful not to overcall SC on core biopsy, as patients diagnosed with SC may receive neoadjuvant therapy. A core biopsy diagnosis of “phyllodes tumor” is specific for PT and can guide treatment planning of a wide local excision.",
keywords = "Core biopsy, Fibroepithelial lesion, Malignant phyllodes tumor, Phyllodes tumor, Sarcomatoid carcinoma",
author = "Ware, {Alisha D.} and Pedram Argani and Cimino-Mathews, {Ashley M}",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s10549-019-05350-5",
language = "English (US)",
journal = "Breast Cancer Research and Treatment",
issn = "0167-6806",
publisher = "Springer New York",

}

TY - JOUR

T1 - Accuracy and clinical implications of pre-operative breast core needle biopsy diagnoses of fibroepithelial neoplasms and sarcomatoid carcinomas

AU - Ware, Alisha D.

AU - Argani, Pedram

AU - Cimino-Mathews, Ashley M

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Purpose: Accurate classification of breast phyllodes tumors (PTs) on core biopsy can be challenging. The differential diagnosis of benign PT (BP) is fibroadenoma (FA), whereas the differential diagnosis of malignant PT (MP) is sarcomatoid (metaplastic) carcinoma (SC). Methods: Here, we compare the pre-excision core biopsy diagnosis and clinicopathologic features of histologically confirmed MP, borderline PT (BLP), BP, FA, and SC. Consecutive cases of 34 histologically confirmed PT (14 MP, 10 BLP, 10 BP), 13 SC, and 10 FA were identified. Results: A core biopsy diagnosis of SC was made only in SC (77%, p = 0.003). The diagnosis “malignant neoplasm” or “atypical spindle cell neoplasm” was made in 100% MP and 23% SC, but no other tumor (p = 0.0001). The diagnosis “phyllodes tumor” was made only in PT (44% BLP, 11% BP, p = 0.06). The diagnosis “fibroepithelial lesion” was made in 44% BLP, 67% BP, and 29% FA. The diagnosis “FA” was made most commonly in FA (57%) (versus 22% BP and no other tumor; p = 0.002). Neoadjuvant therapy was given only in SC (23%, p = 0.03); adjuvant therapy was given in 46% SC and 13% MP (p = 0.04). Conclusions: A pre-operative core biopsy diagnosis of “malignant spindle cell neoplasm” separates MP and SC from BLP, BP, and FA. However, MP and SC can have overlapping features on core biopsy. Thus, one must be careful not to overcall SC on core biopsy, as patients diagnosed with SC may receive neoadjuvant therapy. A core biopsy diagnosis of “phyllodes tumor” is specific for PT and can guide treatment planning of a wide local excision.

AB - Purpose: Accurate classification of breast phyllodes tumors (PTs) on core biopsy can be challenging. The differential diagnosis of benign PT (BP) is fibroadenoma (FA), whereas the differential diagnosis of malignant PT (MP) is sarcomatoid (metaplastic) carcinoma (SC). Methods: Here, we compare the pre-excision core biopsy diagnosis and clinicopathologic features of histologically confirmed MP, borderline PT (BLP), BP, FA, and SC. Consecutive cases of 34 histologically confirmed PT (14 MP, 10 BLP, 10 BP), 13 SC, and 10 FA were identified. Results: A core biopsy diagnosis of SC was made only in SC (77%, p = 0.003). The diagnosis “malignant neoplasm” or “atypical spindle cell neoplasm” was made in 100% MP and 23% SC, but no other tumor (p = 0.0001). The diagnosis “phyllodes tumor” was made only in PT (44% BLP, 11% BP, p = 0.06). The diagnosis “fibroepithelial lesion” was made in 44% BLP, 67% BP, and 29% FA. The diagnosis “FA” was made most commonly in FA (57%) (versus 22% BP and no other tumor; p = 0.002). Neoadjuvant therapy was given only in SC (23%, p = 0.03); adjuvant therapy was given in 46% SC and 13% MP (p = 0.04). Conclusions: A pre-operative core biopsy diagnosis of “malignant spindle cell neoplasm” separates MP and SC from BLP, BP, and FA. However, MP and SC can have overlapping features on core biopsy. Thus, one must be careful not to overcall SC on core biopsy, as patients diagnosed with SC may receive neoadjuvant therapy. A core biopsy diagnosis of “phyllodes tumor” is specific for PT and can guide treatment planning of a wide local excision.

KW - Core biopsy

KW - Fibroepithelial lesion

KW - Malignant phyllodes tumor

KW - Phyllodes tumor

KW - Sarcomatoid carcinoma

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