Abstract

JOURNAL OF MEDICAL AND SURGICAL RESEARCH - Vol. X, n 2, December 2023

Pages: 1255-1266

Core Needle Biopsy Diagnosis of Fibroepithelial Lesions of the Breast in the Moroccan patients: Accuracy and Diagnostic Challenges

Hasnae Ismaili, Layla Tahiri El Ousrouti , Abdelaziz Banani, Moulay Abdelilah Malhouf, Mustapha Maaroufi, Hinde El Fatemi

Category: JMSR Pathology

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Abstract:

Introduction : Breast fibroepithelial lesions (FELs) are biphasic neoplasms consisting of proliferative epithelial and stromal components. It comprises the spectrum of fibroadenomas (FAs) and phyllodes tumors (PTs). Core needle biopsy (CNB) provides a pathological basis, helping in diagnosing fibroepithelial lesions. However, the overlapping spectrum of histological appearance in FELs gives rise to diagnostic problems and may comprise the development of appropriate therapeutic plans. The purpose of this study is to analyze the accordance between CNB and excision diagnoses of FEL patients and evaluate the accuracy of CNB in preoperative diagnoses. Methods: A retrospective review from the medical records of 68 female patients who underwent preoperative CNB and surgical excision (SE) at university hospital Hassan II in 2022 was performed. Results: In our study, the concordant rate of diagnosis between CNB and SE is about 50%. Of the FAs diagnosed on CNB (44 %), 90 % showed a complete match with surgical results and 10 % revealed to be a PT. On CNB, 10 % of the cases were diagnosed as PT and showed total concordance with the SE results. We concluded to a FEL in 46 % of the cases. On surgical excision, 60 % revealed to be FA and 40 % revealed to be PT. Discussion: The differential diagnosis of fibroepithelial tissues in CNB is sometimes challenging. A multidisciplinary approach is a reliable strategy to distinguish between the different FELs.The distinction between the two lesions is challenging sometimes, especially with some FA variants (e.g. cellular FA). The main differential diagnosis of a malignant phyllode is spindle cell metaplastic carcinoma. The treatment is dissimilar. Therefore, it is imperative to differentiate between these lesions. Herein, a comparative table of various studies results :

Maliha latif et al. (2021)	28,8 % patients who had pt at excisional biopsy were diagnosed as fa on biopsy ¹ ( vs 10 % in our study).
Gabriel Marcil et al. (2017)	The surgical excision of FEL diagnosed on CNB yield a pathological diagnosis of FA in 62,5 % and PT in 37,5 % ² (vs 60 % FA and 40 % PT in our study).
Resetkova et al. ( 2010)	In 43 cases of excised fels, 30 % were benign pts, 53 % were fas and 17% were benign cellular fels ³ (vs 60% FA and 40 % PT in our study).

Conclusion : The assessment of histopathological features of FELs on CNB can be subjective. The overlapping spectrum of histological appearance in FEL and sampling limitations of CNB may need more investigation. Immunohistochemistry is helpful but limited. Recent advances in molecular characterisation of FEL appear promising.

Keywords: Fibroepithelial lesion, Core needle biopsy, Breast.

References:

1. Maliha Latif et al. Diagnosis on excision biopsy of breast tissues labeled as fibroepithelial tumors on trucut samples in a developing country. 2021.
2. Gabriel Marcil et al ; Fibroepithelial breast lesions diagnosed by core needle biopsy demonstrate a moderate rate of upstaging to phyllods tumors. 2016.
3. Resetkova E. et al . Clinical and radiological data and core needle biopsy finding should dictate management of cellular fibroepithelial tumors of the breast. Breast J. 2010.