Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, CH-8091, Zurich, Switzerland.
Department of Internal Medicine, Spital Zollikerberg, Zollikerberg, Switzerland.
J Cancer Res Clin Oncol. 2024 Sep 28;150(9):436. doi: 10.1007/s00432-024-05934-9.
Fibroepithelial lesions (FEL) are a heterogeneous group of biphasic tumours that include fibroadenomas (FA) and the rare entity of benign phyllodes tumors (PT) as well as cases where distinction between these two entities is not possible. The histologic distinction between benign PT and cellular FA is still a diagnostic challenge, especially in core-needle biopsy (CNB) or vacuum-assisted biopsy (VAB). Guidelines are not clearly established regarding the management of FEL in CNB or VAB. In this study, we addressed the frequency of B3 FEL diagnosed in CNB or VAB and compared the final histopathological findings in the excision specimens to evaluate up- or downgrading.
We identified 117 female patients with the preoperative diagnosis of FEL (B3), PT, or FEL in combination of pure epithelial B3 lesions in CNB or VAB. Clinico-pathological information as well as data on subsequent surgical excision were available for all patients.
PT was diagnosed in 9 (14.8%) and FEL (B3) in 52 (85.2%) cases. Additionally, 56 patients with FA in combination with an additional B3 lesion were identified. Most FEL (B3)/PT initial diagnoses were made in CNB (55.6% of PT; 84.6% of FEL). After the initial biopsy, 7 of 9 (77.8%) patients with initial diagnosis of benign or borderline PT in CNB/VAB and 40 of 52 (77.0%) patients with initial diagnosis of FEL (B3) in CNB/VAB underwent open excision (OE). 4 of 9 cases (44.4%) initially diagnosed as PT were verified, whereas 2 of 9 (22.2%) were downgraded to FA. 20 of 52 cases (38.5%) initially diagnosed as FEL (B3) were downgraded to FA, whereas 11 of 52 cases (21.2%) were diagnosed as benign or borderline PT. One FEL (B3) case was upgraded to malignant PT.
Most PT and FEL (B3) diagnoses on CNB/VAB underwent surgical removal. In the final pathological findings of cases classified primarily as FEL (B3), the majority were downgraded to FA, one quarter were upgraded to PT, and a small subset remained as combined FA/PT. In clinical daily practice, we recommend individualized decision-making considering different options (clinical follow-up or removal of the lesion depending on the whole context) in a multidisciplinary preoperative conference.
纤维上皮性病变（FEL）是一组异质性的双相肿瘤，包括纤维腺瘤（FA）和罕见的良性叶状肿瘤（PT），以及两者难以区分的病例。在核心针活检（CNB）或真空辅助活检（VAB）中，良性 PT 和细胞性 FA 之间的组织学区别仍然是一个诊断挑战，特别是在 CNB 或 VAB 中。关于 CNB 或 VAB 中 FEL 的管理，指南尚未明确规定。在这项研究中，我们调查了在 CNB 或 VAB 中诊断为 B3 FEL 的频率，并比较了切除标本中的最终组织病理学发现，以评估升级或降级。
我们确定了 117 名女性患者，术前诊断为 FEL（B3）、PT 或 FEL 与纯上皮性 B3 病变在 CNB 或 VAB 中的联合。所有患者均有临床病理资料和随后手术切除的数据。
PT 诊断为 9 例（14.8%），FEL（B3）诊断为 52 例（85.2%）。此外，还发现了 56 例伴有额外 B3 病变的 FA 患者。大多数 FEL（B3）/PT 的初始诊断是在 CNB 中做出的（PT 的 55.6%；FEL 的 84.6%）。在初次活检后，9 例中初始诊断为良性或交界性 PT 的患者中有 7 例（77.8%）和 52 例中初始诊断为 FEL（B3）的患者中有 40 例（77.0%）接受了开放性切除（OE）。9 例中 4 例（44.4%）初始诊断为 PT 得到证实，而 9 例中 2 例（22.2%）降为 FA。52 例中初始诊断为 FEL（B3）的患者中有 20 例（38.5%）降为 FA，而 52 例中有 11 例（21.2%）诊断为良性或交界性 PT。1 例 FEL（B3）病例升级为恶性 PT。
在 CNB/VAB 上做出的大多数 PT 和 FEL（B3）诊断均进行了手术切除。在最初被归类为 FEL（B3）的病例的最终病理结果中，大多数降为 FA，四分之一升为 PT，一小部分仍为 FA/PT 联合病变。在临床日常实践中，我们建议在多学科术前会议上根据不同的选择进行个体化决策（根据整体情况进行临床随访或切除病变）。
