Cellular fibroadenoma versus phyllodes tumors: A pre-operative diagnostic approach based on radiological and cytological features.

OBJECTIVE

This study has been designed in an effort to identify the clinico-radiological and cytological features that could effectively help in differentiating cellular fibroadenoma (CFA) and phyllodes tumors (PT), which have several overlapping characteristics.

METHOD

Histologically proven cases of CFA and PT were reviewed. Cytological features were assessed and categorized. Clinical and radiological details were also evaluated and he the two groups were compared statistically.

RESULTS

A total of 43 FA and 52 PT were specimens were reviewed. Mean age and tumor size for CFA and PT were 26.05 and 36.94 years, and 3.7 and 6.4 cm, respectively. Univariate analysis and regression models revealed that age >30 years, BIRADS grade of 4 or more, marked cellularity of stromal fragments, more than 30% spindle cells in background cell population and presence of traversing blood vessels in stromal fragments increased the odds of a tumor being phyllodes. The binary logistic regression model was able to predict PT accurately in 87.2% cases (p <  .001).

CONCLUSION

PT and CFA could be differentiated if cytological findings are cautiously correlated clinically and radiologically. Age, BIRADS category along with assessment of stromal fragments and background population can effectively distinguish between CFA and PT.