Evidence map›Paper›PMID 38851660›Full record

ArticleBreast cancer research and treatment2024

De-escalating indications for excision when breast core needle biopsy returns fibroepithelial lesion-not further characterized.

Tahereh Soleimani, David Euhus, Olutayo Sogunro, Leslie Cope, Mahin Janjua, Mahtab Vasigh, Lisa K Jacobs

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Article in Breast cancer research and treatment, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

7 authors.

Tahereh SoleimaniDepartment of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
David EuhusDepartment of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. deuhus1@jhmi.edu.ORCID https://orcid.org/0000-0002-7832-1774
Olutayo SogunroDepartment of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Leslie CopeDepartment of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Mahin JanjuaHoward University, Washington, DC, USA.
Mahtab VasighDepartment of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Lisa K JacobsDepartment of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeSurgical excision is often performed to exclude phyllodes tumor (PT) when Core Needle Biopsy (CNB) of the breast returns fibroepithelial lesion-not further characterized (FEL-NFC). If imaging or CNB pathology features can be identified that predict a very low probability of borderline/malignant PT, thousands of women could be spared the expense and morbidity of surgical excisions.

methodsThis retrospective cohort study includes 180 FEL-NFC from 164 patients who underwent surgical excisional biopsy.

resultsThe upgrade rate from FEL-NFC to benign PT was 15%, and to borderline/malignant PT 7%. Imaging features predicting upgrade to borderline/malignant PT included greater size (p = 0.0002) and heterogeneous echo pattern on sonography (p = 0.117). Histologic features of CNB predicting upgrade to borderline/malignant PT included "pathologist favors PT" (p = 0.012), mitoses (p = 0.014), stromal overgrowth (p = 0.006), increased cellularity (p = 0.0001) and leaf-like architecture (p = 0.077). A three-component score including size > 4.5 cm (Size), heterogeneous echo pattern on sonography (Heterogeneity), and stromal overgrowth on CNB (Overgrowth) maximized the product of sensitivity x specificity for the prediction of borderline/malignant PT. When the SHO score was 0 (72% of FEL-NFC) the probability of borderline/malignant PT on excision was only 1%.

conclusionThe combination of size ≤ 4.5 cm, homogeneous echo pattern, and absence of stromal overgrowth is highly predictive of a benign excision potentially sparing most patients diagnosed with FEL-NFC the expense and morbidity of a surgical excision.

Indexed as

Breast NeoplasmsPhyllodes TumorAdultAgedBiopsy, Large-Core NeedleBreastFemaleHumansMiddle AgedRetrospective StudiesYoung AdultBreast core biopsyFibroadenomaFibroepithelial lesionPhyllodesSurgical excision

Identifiers

PMID38851660

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.