Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA.
Breast J. 2010 Nov-Dec;16(6):573-80. doi: 10.1111/j.1524-4741.2010.01013.x.
Fibroepithelial lesions with cellular stroma identified on core needle biopsy (CNB) may prove to be either fibroadenoma or phyllodes tumor at excision; therefore, management of these rare lesions is highly controversial. We aim to assess the management and the outcome of 101 cellular fibroepithelial lesions diagnosed on CNB over a 6-year period in one institution. Consensus on clinical management in each individual patient was reached during multi-disciplinary conferences, based on careful correlation of clinical data with results of imaging studies and pathology of CNB samples. Radiologic findings (mammogram and sonogram) and multiple histologic parameters on CNB specimen were blindly re-evaluated by one experienced breast radiologist and two breast pathologists, respectively, and results were correlated with final diagnosis at excision. Cellular fibroepithelial lesions with indeterminate or suspect imaging findings, with larger size, and with an equivocal comment such as "cannot rule out phyllodes tumor" in the pathology report were excised more frequently (p = 0.05, p = 0.034, and p = 0.01, respectively). Of 43 excised lesions, 13 were classified as benign phyllodes tumors, 23 as fibroadenoma and seven as benign cellular fibroepithelial lesion. The final diagnosis at excision did not significantly correlate with any clinical data, or with retrospective evaluation of imaging findings or comprehensive evaluation of multiple histologic parameters. In 58 patients who had clinical and radiologic follow-up (mean ± SD: 30 ± 21 months) there was no evidence of disease progression. No clinical and radiologic findings and/or comprehensive evaluation of multiple histologic parameters on CNB specimen are distinctive enough to predict final classification of equivocal cellular fibroepithelial lesions. However, careful clinico-pathologic and radiologic correlation may help to select the most clinically significant lesions for proper immediate surgical management. Follow-up alone may be an appropriate alternative for a subset of patients, given a good clinical, pathologic, and radiologic correlation.
在核心针活检 (CNB) 上识别出具有细胞基质的纤维上皮病变可能在切除时被证明为纤维腺瘤或叶状肿瘤；因此，这些罕见病变的处理极具争议。我们旨在评估在一个机构的 6 年内通过 CNB 诊断的 101 例细胞纤维上皮病变的处理方法和结果。在多学科会议上，根据仔细关联临床数据与影像学研究和 CNB 样本病理学结果，就每位患者的临床处理达成共识。一位有经验的乳腺放射科医生和两位乳腺病理学家分别对 CNB 标本的放射学发现（乳房 X 线照片和超声）和多个组织学参数进行了盲法重新评估，并将结果与切除时的最终诊断相关联。具有不确定或可疑影像学表现、较大尺寸的细胞纤维上皮病变，以及病理学报告中出现“不能排除叶状肿瘤”等不确定意见的病变，切除更为频繁（p = 0.05、p = 0.034 和 p = 0.01）。在 43 例切除病变中，13 例被分类为良性叶状肿瘤，23 例为纤维腺瘤，7 例为良性细胞纤维上皮病变。切除时的最终诊断与任何临床数据、回顾性评估影像学表现或综合评估多个组织学参数均无显著相关性。在有临床和放射学随访的 58 例患者中（平均 ± 标准差：30 ± 21 个月），没有疾病进展的证据。CNB 标本上的任何临床和放射学发现和/或综合评估多个组织学参数都不足以准确预测不确定的细胞纤维上皮病变的最终分类。然而，仔细的临床病理和放射学关联可能有助于选择最具临床意义的病变进行适当的立即手术治疗。对于具有良好临床、病理和放射学相关性的患者亚组，单独随访可能是一种合适的替代方法。
