Jessica Limberg1, Kelly Barker1, Syed Hoda2, Rache Simmons1, Aya Michaels3, Jennifer L Marti4. 1. Department of Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 420 East 70th St, Room 251, New York, NY, 10021, USA. 2. Department of Pathology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA. 3. Department of Radiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA. 4. Department of Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 420 East 70th St, Room 251, New York, NY, 10021, USA. Jem9080@med.cornell.edu.
Abstract
BACKGROUND: When needle core biopsies (NCBs) of the breast reveal fibroepithelial lesions (FELs), excision is often performed to rule out a phyllodes tumor (PT), despite low malignancy rates. Consequently, the natural history of observed FELs is not well described. We analyzed the malignancy risk in excised FELs and the natural history of FELs undergoing active surveillance (AS). METHODS: We retrospectively studied the pathology and imaging records of 215 patients with FELs (n = 252) diagnosed on NCB. Incidence of growth was determined by Kaplan-Meier method. RESULTS: Of 252 FELs, 80% were immediately excised and 20% underwent AS. Of the excised FELs, 198 (98%) were benign: fibroadenoma (FA) or benign breast tissue in 137 (68%), benign PT in 59 (29%), or LCIS in 2 (1%). Borderline PT or malignant lesions were found in 4 (2%). On ultrasound, malignant and borderline PTs were larger than benign lesions [median 3.9 vs 1.3 cm, p = 0.006]. Fifty FELs underwent AS, with a median follow-up of 17 (range 2-79) months. The majority remained stable or decreased in size: at 2 years, only 35% increased in volume by ≥ 50%. Of those tumors undergoing AS that were later excised (n = 4), all were benign. CONCLUSIONS: Almost all FELs (98%) were benign on surgical excision, and the majority undergoing AS remained stable, with benign pathology if later excised. Most FELs on NCB can be safely followed with US, with surgery reserved for patients with FELs that are large, symptomatic, or growing. This could spare most women with FELs unnecessary surgery.
BACKGROUND: When needle core biopsies (NCBs) of the breast reveal fibroepithelial lesions (FELs), excision is often performed to rule out a phyllodes tumor (PT), despite low malignancy rates. Consequently, the natural history of observed FELs is not well described. We analyzed the malignancy risk in excised FELs and the natural history of FELs undergoing active surveillance (AS). METHODS: We retrospectively studied the pathology and imaging records of 215 patients with FELs (n = 252) diagnosed on NCB. Incidence of growth was determined by Kaplan-Meier method. RESULTS: Of 252 FELs, 80% were immediately excised and 20% underwent AS. Of the excised FELs, 198 (98%) were benign: fibroadenoma (FA) or benign breast tissue in 137 (68%), benign PT in 59 (29%), or LCIS in 2 (1%). Borderline PT or malignant lesions were found in 4 (2%). On ultrasound, malignant and borderline PTs were larger than benign lesions [median 3.9 vs 1.3 cm, p = 0.006]. Fifty FELs underwent AS, with a median follow-up of 17 (range 2-79) months. The majority remained stable or decreased in size: at 2 years, only 35% increased in volume by ≥ 50%. Of those tumors undergoing AS that were later excised (n = 4), all were benign. CONCLUSIONS: Almost all FELs (98%) were benign on surgical excision, and the majority undergoing AS remained stable, with benign pathology if later excised. Most FELs on NCB can be safely followed with US, with surgery reserved for patients with FELs that are large, symptomatic, or growing. This could spare most women with FELs unnecessary surgery.
Authors: Dara S Ross; Dilip D Giri; Muzaffar M Akram; Jeffrey P Catalano; Cristina Olcese; Kimberly J Van Zee; Edi Brogi Journal: Breast J Date: 2016-11-04 Impact factor: 2.431
Authors: Daniel J Gould; Jessica A Salmans; Brian K Lassinger; Alejandro Contreras; Carolina Gutierrez; Elizabeth Bonefas; Kathleen R Liscum; Eric J Silberfein Journal: J Surg Res Date: 2012-04-14 Impact factor: 2.192
Authors: Andrew D Van Osdol; Jeffrey Landercasper; Jeremiah J Andersen; Richard L Ellis; Erin M Gensch; Jeanne M Johnson; Brooke De Maiffe; Kristen A Marcou; Mohammed Al-Hamadani; Choua A Vang Journal: JAMA Surg Date: 2014-10 Impact factor: 14.766