Phyllodes Tumors Of The Breast:Diagnostic Performance Of Core Needle Biopsy And Prognostic Factors Related With Local Recurrence

Part 1:Diagnostic performance of core needle biopsy in breast phyllodes tumorsPurpose:A retrospective analysis of patients with phyllodes tumors of the breast (PTB) who received pre-operative core needle biopsy (CNB) and had breast surgery in Shanghai Cancer Center, Fudan University from January 1,2002 to April 1,2013. To compare the accordance between CNB and excision diagnoses of PTB patients and evaluate the accuracy of CNB in the performance of pre-operative diagnosis.Materials and methods:Data of 128 patients with PTB who had undergone pre-operative CNB and breast surgery were retrospectively analyzed. The medical history information, clinical follow-up, the diagnostic data of CNB and surgical excision of these PTB patients were reviewed, and the clinico-pathologic variables were compared with the accordance of CNB diagnoses of PTB using chi-square or t test. Diagnostic test was used to evaluate the sensitivity of CNB in diagnosing benign, borderline and malignant phyllodes tumors.Results:The accuracy of CNB for diagnosing PTB was 13.3%(17/128).98 patients consisted of 75.5% of PTB patients were diagnosed with fibroadenoma or fibro-epithelial lesions. The sensibility of CNB to diagnose benign/borderline/ malignant phyllodes tumors was 4.9%(2/41)/4.2%(3/71)/25.0%(4/16). Clinical features as large tumor size, rapid growth or surgical history of fibroadenomas can indicate a greater possibility of PTB diagnosis.Conclusions:CNB provides pathological basis for pre-operative diagnosis of PTB with low accuracy and limited guiding role for surgical decisions. CNB inspections in combination with clinical and image features as a triple assessment was suggested to assist CNB diagnostic judgements.Part 2:Prognostic factors related to local recurrence in breast phyllodes tumors: analysis of 404 case in a single institutionPurpose:Retrospectively analyzed 404 cases of breast phyllodes tumors (PTB) who had breast surgery in Shanghai Cancer Center, Fudan University from January 1,2002 to April 1,2013. To review the clinico-pathologic features, recurrent and metastasis pattern, operation and adjuvant radiotherary treatments. To investigate prognostic factor associated with local recurrence.Materials and methods:Pathological features of 404 PTB patients were reviewed by specialists. Benign PTBs were devided into low-risk group, while borderline and malignant PTBs were devided into high-risk group. Clinico-pathologic features, surgery treatments and adjuvant radiotherapy were analyzed to investigate prognostic factors associated with low and high risk groups.Results:404 cases of PTB included 168 benign (41.6%),184 borederline (45.5%) and 52 malignant (12.9%) patients. In 54 cases (13.7%) that developed local recurrence,6 cases were benign,26 were borderline and 22 were malignant. Local recurrence rate was 3.6%/14.1%/42.3% in benign/borderline/malignant cases. Stromal cellular atypia was independent prognostic factor for recurrence-free survival (RFS) in low risk group, while surgery treatment and tumor border were independent prognostic factors for RFS in high risk groups.Conclusions:Histological types and stromal status were closely related with local recurrence of PTB. High risk group patients should choose wide local excision or mastectomy as surgery treatment based on comprehensive consideration of clinical manifestations, tumor grade, borders, stromal status and mitotic activity. The theraputic effect of adjuvant radiotherapy has not been determined. PTB patients with high risk may considered to receive radiotherapy after resection of local recurrence.