Sonographic and Mammographic Features of Phyllodes Tumours of the Breast: Correlation with Histological Grade

Transcription

1 Sonographic and Mammographic Features of Phyllodes Tumours of the Breast: Correlation with Histological Grade Poster No.: C-0046 Congress: ECR 2014 Type: Authors: Keywords: DOI: Scientific Exhibit C. Y. Lee 1, A. S. L. FUNG 2 ; 1 Hong Kong/CN, 2 Hong Kong, HK/CN Breast, Ultrasound, Mammography, Outcomes analysis, Diagnostic procedure, Neoplasia, Pathology /ecr2014/C-0046 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 9

2 Aims and objectives Breast phyllodes tumors is a rare breast fibroepithelial neoplasm, which can be classified into benign, borderline or malignant histologically. Complete surgical excision with wide margins is important in phyllodes tumours treatment due to their high local recurrence rate. Accurate preoperative diagnosis necessitates correct surgical planning and avoidance of reoperation, especially in borderline and malignant phyllodes tumors. Although ultrasound and mammography are commonly performed for characterization of breast masses, previous literature suggested that differentiation of benign or malignant phyllodes tumors on mammography and sonography could be difficult. 1-3 A more recent study on imaging findings of phyllodes tumours of the breast concluded that tumor size as well as several ultrasound and magnetic resonance imaging findings could be used to help preoperatively determine the histologic grade. 4 Our study aims to correlate the imaging findings of phyllodes tumors on ultrasound and mammography with histological grade, so as to consolidate or verify the recent findings. Methods and materials This is a retrospective study. Patients with surgical excision confirmed breast phyllodes tumors and preoperative imaging performed between 2008 to 2012 were identified by searching through the hospital radiological information system. Preoperative imaging included ultrasound and/or mammography. The sonographic as well as mammographic images and reports of these histologically proven tumors were reviewed, blinded to the pathological results. Reviewed sonographic findings included: size, echogenicity, heterogeneity, shape, margin, vascularity, presence of calcification, presence of cystic component and posterior enhancement. Reviewed mammographic findings included: background breast density, density of mass, shape, margin, associated calcifications, associated parenchymal distortion and presence of radiolucent halo. Page 2 of 9

3 Borderline tumours are assigned into the malignant group assuming low-grade malignancy in the borderline tumours. Correlation of imaging findings with histological grade in benign and malignant groups was made. All data were analyzed using Chisquare test, Fisher's exact test or Mann-Whitney U test. Results A total of 10 phyllodes tumors in 9 patients were included, in which 2 were recurrent phyllodes tumours. Ultrasound was performed in 10 tumours and mammography was performed in 9 tumors. Patients were between 37 and 63 years old with a mean age of tumours were in the right breast and 4 tumors were in the left breast. Numbers of benign, borderline and malignant tumours were 6 (60%), 2 (20%) and 2 (20%) with mean size of 7.0cm, 3.8cm and 4.8cm respectively, which did not show statistical significance between benign (n=6) versus malignant (n=4) groups. Both cases of recurrent phyllodes tumours were benign. None of our patient had metastatic disease at time of diagnosis. Concerning the sonographic findings, all the tumours were heterogeneous (100%), hypoechoic (100%), with posterior acoustic enhancement (100%). None of them contains echogenic focus suggestive of internal calcification. Only irregular shape was found to be significantly correlated with malignant tumours compared with benign tumours (3/4, 75% vs 0/6, 0%, p<0.05). [Figure 1] Page 3 of 9

4 Fig. 1: Example of a malignant phyllodes tumour with irregular shape and ill-defined margin. References: Radiology, Tuen Mun Hospital, Tuen Mun Hospital - Hong Kong/CN Indistinct margin was found in 2/6 (33%) benign tumours and 3/4 (75%) malignant tumours. Increased vascularity was found in 4/6 (67%) benign tumours and 3/4 (75%) malignant tumours. Cystic component was found in 2/6 (33%) benign tumours and 1/4 (25%) malignant tumours. All of these did not demonstrate statistical significance. All sonographic findings were listed in Table 1. Page 4 of 9

5 Table 1: Sonographic Features of Phyllodes Tumours References: Radiology, Tuen Mun Hospital, Tuen Mun Hospital - Hong Kong/CN Mammographically, all phyllodes tumours in our study were either round, oval or lobular in shape. Only 1 out of 9 phyllodes tumours had associated calcification. Rest of the mammographic findings were shown in Table 2. None of the mammographic features demonstrated statistical significance between benign versus malignant groups. Page 5 of 9

6 Table 2: Mammographic Features of Phyllodes Tumours References: Radiology, Tuen Mun Hospital, Tuen Mun Hospital - Hong Kong/CN Images for this section: Page 6 of 9

7 Fig. 1: Example of a malignant phyllodes tumour with irregular shape and ill-defined margin. Page 7 of 9

8 Table 1: Sonographic Features of Phyllodes Tumours Table 2: Mammographic Features of Phyllodes Tumours Page 8 of 9

9 Conclusion We demonstrated that phyllodes tumours were heterogeneous hypoechoic lesions on ultrasound and round, oval or lobular largely well-defined masses on mammograms. Associated calcification was seldom seen. We also demonstrated that irregular shape on ultrasound could be helpful to predict the histological grade of breast phyllodes tumours, while prediction on histological grade using mammography would be difficult. All these findings are consistent with the recent study by Tan et al. 4. Personal information Dr. CY LEE, Dr. Amy SL FUNG, Department of Radiology, Tuen Mun Hospital, Tuen Mun, NT, HKSAR. References 1. Jorge Blanco A, Vargas Serrano B, Rodriguez Romero R, et al. Phyllodes tumors of the breast. Eur Radiol 1999;9(2): Liberman L, Bonaccio E, Hamele-Bena D, et al. Benign and malignant phyllodes tumors: mammographic and sonographic findings. Radiology 1996;198(1): Buchberger W, Strasser K, Heim K, et al. Phyllodes tumor: findings on mammography, sonography, and aspiration cytology in 10 cases. AJR Am J Roentgenol 1991;157(4): Tan H, Zhang S, Liu H, et al. Imaging findings in phyllodes tumors of the breast. Eur J Radiol Jan;81(1):e62-9. Page 9 of 9