Tariq Muhammad Usman, Rani Alka, Kayani Naila, Sattar Abida K, Vohra Lubna, Idress Romana
Histopathology, Al Hada Armed Forces Hospital, Taif, SAU.
Histopathology, Aga Khan University Hospital, Karachi, PAK.
Cureus. 2024 Jul 20;16(7):e64997. doi: 10.7759/cureus.64997. eCollection 2024 Jul.
Background Core needle biopsy (CNB) for fibroepithelial lesions (FELs) of the breast is commonly encountered by histopathologists. The distinction between fibroadenoma (FA) and phyllodes tumor (PT) can be challenging due to overlapping histological features and the limited nature of CNB material. Objective This study aimed to assess the accuracy of CNB diagnosis of FA and PT by comparing it with a diagnosis on subsequent surgical excision specimen. Materials and methods A total of 166 cases of FELs of the breast who underwent CNB and subsequent surgical excision between January 2001 and December 2020 were included in our study. All microscopy glass slides were reviewed, and diagnosis confirmed. Results While 125 (75%) cases based on CNB received a definitive diagnosis of either fibroadenoma or PT, the remaining 41 (25%) cases were better classified on excision specimens and were descriptively diagnosed as fibroepithelial lesions on CNB. Diagnoses on CNB and on subsequent excision specimens were concordant in 113 (90.4%) cases. Among 12 cases that were discordant, three cases diagnosed as FA on CNB were upgraded to PT on excision specimens. Nine cases diagnosed as PT on CNB were diagnosed as FA on excision specimens. These included conventional, cellular, juvenile, and complex FA types. Three PTs, which were reported as FA on CNB, measured 6, 12.5, and 17.5 cm in the greatest dimension. Among 23 cases of PT which were further categorized on CNB, tumor categories changed on excision specimens in three cases. The diagnostic accuracy of CNB diagnosis was 90.4%. Conclusion CNB diagnosis showed good accuracy. PT diagnosis should be strongly considered in all tumors measuring >5 cm, especially those exceeding 10 cm. Cellular, juvenile, and complex FAs can be misdiagnosed as PT on CNB. Correlation with clinical and radiological findings can be helpful in establishing correct diagnosis.
背景 乳腺纤维上皮性病变（FEL）的粗针穿刺活检（CNB）是组织病理学家经常遇到的情况。由于组织学特征重叠以及CNB取材有限，纤维腺瘤（FA）和叶状肿瘤（PT）的鉴别诊断具有挑战性。 目的 本研究旨在通过将CNB诊断与后续手术切除标本的诊断进行比较，评估CNB诊断FA和PT的准确性。 材料与方法 本研究纳入了2001年1月至2020年12月期间接受CNB及后续手术切除的166例乳腺FEL患者。对所有显微镜玻片进行复查并确诊。 结果 基于CNB，125例（75%）患者被明确诊断为纤维腺瘤或叶状肿瘤，其余41例（25%）患者在切除标本上分类更准确，CNB时描述性诊断为纤维上皮性病变。CNB诊断与后续切除标本诊断在113例（90.4%）患者中一致。在12例不一致的病例中，3例CNB诊断为FA的病例在切除标本上升级为PT。9例CNB诊断为PT的病例在切除标本上诊断为FA。这些包括传统型、细胞型、幼年型和复杂型FA。3例CNB报告为FA的PT，最大直径分别为6 cm、12.5 cm和17.5 cm。在23例CNB进一步分类的PT病例中，3例在切除标本上肿瘤分类发生改变。CNB诊断的准确性为90.4%。 结论 CNB诊断显示出良好的准确性。对于所有最大直径>5 cm的肿瘤，尤其是超过10 cm的肿瘤，应高度考虑PT诊断。细胞型、幼年型和复杂型FA在CNB时可能被误诊为PT。与临床和影像学检查结果相结合有助于确立正确诊断。
