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Jung, Ko, Rho, Moon, Kim, Kim, and Park: Can We Predict Phyllodes Tumor among Fibroepithelial Lesions with Cellular Stroma Diagnosed at Breast Core Needle Biopsy?
Original Article

Journal of the Korean Society of Radiology 2011; 64(6): 603-609.

Published online: 30 June 2011

DOI: https://doi.org/10.3348/jksr.2011.64.6.603

Can We Predict Phyllodes Tumor among Fibroepithelial Lesions with Cellular Stroma Diagnosed at Breast Core Needle Biopsy?

Hae Kyoung Jung, M.D.1, Kyung Hee Ko, M.D.1, Ji Young Rho, M.D.1, Hee Jung Moon, M.D.2, Eun Kyung Kim, M.D.2, Min Jung Kim, M.D.2, Byeong Woo Park, M.D.2

1Department of Radiology, CHA University College of Medicine, Korea.

2Department of Radiology, Yonsei University College of Medicine, Korea.

Address reprint requests to: Eun-Kyung Kim, M.D., Department of Radiology, Yonsei University College of Medicine 250 Seongsanno, Seodaemun-gu, Seoul 120-752, Korea. Tel. 82-2-2228-7400, Fax. 82-2-393-3035, ekkim@yuhs.ac

Received 27 October 2010       Accepted 15 April 2011

Copyright © 2011 The Korean Society of Radiology

Abstract

Purpose

To evaluate the surgical outcomes of fibroepithelial lesion with cellular stroma (FELCS) diagnosed at sonography guided core needle biopsy of breast masses, and to determine whether the clinical and imaging features of this lesion could predict the presence of a phyllodes tumor.

Materials and Methods

We retrospectively reviewed the pathologic results of sonography guided core needle biopsy of solid breast masses. A total of 55 FELCS diagnosed with this procedure that underwent subsequent surgical excision were included in this study; their medical records and radiologic images were retrospectively reviewed.

Results

The results of the surgical excision revealed 22 (40%) phyllodes tumors and 33 (60%) non-phyllodes tumors: 30 (54.6%) fibroadenomas, 1 (1.8%) adenosis, 1 (1.8%) fibrocystic changes and 1 (1.8%) fibroadenomatous hyperplasia. Lesion size and patient age were significantly different between phyllodes tumors and non-phyllodes tumors groups (32.2 ± 14.07 mm/22.4 ± 13.64 mm, p=0.0078, 43.5 ± 11.60 years/36.5 ± 10.25 years, p=0.0207). Among the sonographic features, only cleft was significantly more visible in phyllodes tumors than in non-phyllodes tumors (n=14 (70%)/n=6 (30%), p=0.0016).

Conclusion

The size of the lesions, the age of the patients, and the sonographic features of cleft were the significant helpful variables to predict phyllodes tumors among FELCS diagnosed at breast core biopsy.

Keywords: Breast, Phyllodes tumor, Ultrasonography, Biopsy

Figures and Tables

Fig. 1

Decision tree analysis according to Chi-square test.

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Fig. 2

Decision tree analysis according to gini index, entropy index.

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Fig. 3

18-year-old woman with a palpable mass diagnosed as fibroepithelial lesion with cellular stroma at ultrasonography guided core biopsy.

A. Ultrasonography shows a 41 mm sized, irregular, not-circumscribed and hypoechoic mass with clefts categorized as Category 4. It was confirmed as benign phyllodes tumor at surgical excision.
B. Photomicrograph of core needle biopsy specimen shows increased stromal cellularity (arrows) and normal ducts (arrowheads) (H and E, ×40).
C. Photomicrograph of surgical excision specimen shows epithelial lining stroma with significantly increased cellularity, which is more compatible with phyllodes tumor than fibroadenoma (H and E, ×40).
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Fig. 4

32-year-old woman with a palpable mass diagnosed as fibroepithelial lesion with cellular stroma at ultrasonography guided core biopsy ultrasonogram shows a 34 mm sized, oval, not-circumscribed and hypoechoic mass with clefts was categorized as Category 4. It was confirmed as phyllodes tumor at surgical excision.

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Fig. 5

19-year-old woman with a palpable mass diagnosed as fibroepithelial lesion with cellular stroma at ultrasonography guided core biopsy Ultrasonogram shows a 60 mm sized, oval, circumscribed and hypoechoic mass categorized as Category 3. It was confirmed as fibroadenoma at surgical excision.

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Fig. 6

42-year-old woman with a palpable mass diagnosed as fibroepithelial lesion with cellular stroma at ultrasonography guided core biopsy Ultrasonogram shows a 16 mm sized, oval, circumscribed and hypoechoic mass categorized as Category 3. It was confirmed as fibroadenoma at surgical excision.

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Table 1

Ultrasonographic Features of Phyllodes Tumors and Non-phyllodes Tumors

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Note.─ *; Student t test

† Fisher's exact test

Acknowledgement

This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (2009-0067048).

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