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Accuracy and clinical implications of pre-operative breast core needle biopsy diagnoses of fibroepithelial neoplasms and sarcomatoid carcinomas

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Abstract

Purpose

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).

Methods

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.

Results

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).

Conclusions

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 overlap** 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.

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Authors and Affiliations

  1. The Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, USA

    Alisha D. Ware

  2. The Departments of Pathology and Oncology, The Johns Hopkins Hospital, 401 N. Broadway St, Weinberg 2242, Baltimore, MD, 21287, USA

    Pedram Argani & Ashley Cimino-Mathews

Authors
  1. Alisha D. Ware
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  2. Pedram Argani
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  3. Ashley Cimino-Mathews
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Correspondence to Ashley Cimino-Mathews.

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Conflict of interest

Dr. Cimino-Mathews receives research grants from Bristol-Myers Squibb and the HeritX foundation, unrelated to the work presented in this current study. Drs. Ware and Argani declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors. The study is approved by the Johns Hopkins Institutional Review Board to utilize de-identified, archival pathology specimens.

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Ware, A.D., Argani, P. & Cimino-Mathews, A. Accuracy and clinical implications of pre-operative breast core needle biopsy diagnoses of fibroepithelial neoplasms and sarcomatoid carcinomas. Breast Cancer Res Treat 178, 51–56 (2019). https://doi.org/10.1007/s10549-019-05350-5

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