The Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, USA.
The Departments of Pathology and Oncology, The Johns Hopkins Hospital, 401 N. Broadway St, Weinberg 2242, Baltimore, MD, 21287, USA.
Breast Cancer Res Treat. 2019 Nov;178(1):51-56. doi: 10.1007/s10549-019-05350-5. Epub 2019 Jul 22.
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).
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.
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).
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.
在核心活检中准确分类乳腺叶状肿瘤（PT）具有挑战性。良性叶状肿瘤（BP）的鉴别诊断为纤维腺瘤（FA），而恶性叶状肿瘤（MP）的鉴别诊断为梭形细胞癌（SC）。
在此，我们比较了经组织学证实的 MP、交界性叶状肿瘤（BLP）、BP、FA 和 SC 的术前核心活检诊断和临床病理特征。连续纳入 34 例经组织学证实的 PT（14 例 MP、10 例 BLP、10 例 BP）、13 例 SC 和 10 例 FA。
SC 仅在 SC 中做出核心活检诊断（77%，p=0.003）。MP 和 23%的 SC 中做出“恶性肿瘤”或“非典型梭形细胞肿瘤”的诊断，但其他肿瘤中未做出该诊断（p=0.0001）。PT 中仅做出“叶状肿瘤”的诊断（44%的 BLP、11%的 BP，p=0.06）。44%的 BLP、67%的 BP 和 29%的 FA 中做出“纤维上皮性病变”的诊断。FA 中最常做出“FA”的诊断（57%）（与 22%的 BP 和其他肿瘤不同；p=0.002）。仅在 SC 中给予新辅助治疗（23%，p=0.03）；SC 中给予辅助治疗 46%，MP 中给予辅助治疗 13%（p=0.04）。
术前核心活检中“恶性梭形细胞肿瘤”的诊断将 MP 和 SC 与 BLP、BP 和 FA 区分开来。然而，MP 和 SC 在核心活检上可能具有重叠特征。因此，必须注意不要在核心活检上过度诊断 SC，因为诊断为 SC 的患者可能会接受新辅助治疗。“叶状肿瘤”的核心活检诊断对 PT 具有特异性，并可指导广泛局部切除的治疗计划。
