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Excision of breast fibroepithelial lesions: when is it still necessary?—A 10-year review of a regional centre

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Abstract

Purpose

Fibroepithelial lesions (FEL) range from benign fibroadenoma (FA) to malignant phyllodes tumor (PT), but can be difficult to diagnose on core needle biopsy (CNB). This study assesses risk factors for phyllodes tumor (PT) and recurrence and whether a policy to excise FELs over 3 cm in size is justified.

Methods

Patients having surgery for FELs from 2009 to 2018 were identified. The association of clinical, radiology and pathological features with PT and recurrence were evaluated. Trend analysis was used to assess risk of PT based on imaging size.

Results

Of the 616 patients with FELs, 400 were identified as having FA on CNB and 216 were identified as having FEL with a comment of concern for phyllodes tumor (query PT, QPT). PT was identified in 107 cases; 28 had CNB of FA (7.0%), while 79 had QPT (36.6%). Follow-up was available for 86 with a mean of 56 months; six patients had recurrence of PT, all of whom had QPT on CNB. The finding of PT was associated with CNB of QPT, increasing age and size on multivariate logistic regression. All patients diagnosed with PT following CNB of FA had enlarging lesions with a mean size of 38.3 mm.

Conclusions

Our data does not support routine excision of FELs based on size alone. All patients with QPT on CNB, regardless of size should consider excision due to high risk of PT and recurrence, and the decision to excise FAs to rule out PT should also consider whether the lesion is enlarging.

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Data availability

All data generated or analysed during this study are reported in this published article.

Code availability

N/A.

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Acknowledgements

The authors would like to acknowledge the input of the physicians in the Departments of Pathology, Surgery, and Radiology in our area that contributed to the development of our clinical pathways. We would also like to acknowledge Dr. Betty Wen and Arveen Gogoani, who helped with data collection and Mabel Zhang and Crystal Ma, who helped with manuscript preparation.

Funding

There was no funding for this study.

Author information

Authors and Affiliations

  1. Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada

    Carol K. Dingee, Amy Bazzarelli, Urve Kuusk, Jin-Si Pao, Rebecca Warburton & Elaine C. McKevitt

  2. Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada

    Dorsa Mousa-Doust, Carol K. Dingee, Leo Chen, Amy Bazzarelli, Urve Kuusk, Jin-Si Pao, Rebecca Warburton & Elaine C. McKevitt

Authors
  1. Dorsa Mousa-Doust
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  2. Carol K. Dingee
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  3. Leo Chen
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  4. Amy Bazzarelli
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  8. Elaine C. McKevitt
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Contributions

All authors contributed to the study conception and design. DM-D, CD, AB, UK, J-SP, RW and EM: Material preparation and data collection; DM-D, EM, and LC: analysis; the first draft of the manuscript was written by DM-D and EM and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Elaine C. McKevitt.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This retrospective study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The research ethics board of the University of British Columbia and Providence Health care approved this study.

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Mousa-Doust, D., Dingee, C.K., Chen, L. et al. Excision of breast fibroepithelial lesions: when is it still necessary?—A 10-year review of a regional centre. Breast Cancer Res Treat 194, 307–314 (2022). https://doi.org/10.1007/s10549-022-06631-2

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  • DOI: https://doi.org/10.1007/s10549-022-06631-2

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