Phyllodes tumor? Fibroadenoma? İmaging techniques to recognize contribution

Purpose: The objective of this study is to compare MG and US results with histopathology, which is the gold standard, in diagnosing phyllodes breast tumor and fibroadenoma that is confused with phyllodes tumor by radiological imaging methods and in differentiating these two kinds of tumor, and to show the contribution of breast MR to these classic methods. Materials and Methods: 142 cases aged between 13 and 83 who have got excisional biopsy at the Department of Surgery of Dokuz Eylul University and have been diagnosed with fibroadenoma and phyllodes tumor at the Department of Pathology between the years of 2000 and 2013 have been included in this study. Out of 142 cases there have been 70 cases with phyllodes tumor and 72 cases with fibroadenoma. 140 cases have been evaluated with breast US, 103 cases have been evaluated with MG and 20 cases have been evaluated with MR. Mammography examinations have been done in cranio-caudal (CC) and mediolateral-oblique (MLO) positions which are the protocol for routine examination. Additional examination positions have been applied to the patients who make it necessary. B-mode US examinations have been simultaneously done with the same device and probe in concurrence with Color Doppler US examinations. The number of veins and the location of them within lesion and around lesion have been pathologically evaluated with Color Doppler. All patients? breast MR examinations have been done with the device of 1,5 Tesla MR and SENSE Parallel imaging by using breast coil in order to increase SNR. All patients have underwent axial TSE T1 and T2-weighted with fat suppression, T1-weighted Gradient Eco, dynamic contrast-enhanced T1-weighted axial and pos contrast T1-weighted axial sequences as routine MR parameters. The cases have been evaluated in accordance with BI-RADS measure in all imaging methods. In addition to evaluation of the mass for size, location, shape, margin and border characteristics, echogenicity, density, internal structure and vascularity, breast parenchyma pattern and axials and lymphadenopathy accompanying the mass have been examined in all imaging methods and it has been investigated whether the mass has a structural distortion and calcification as well. Additionally, dynamic contrast characteristics and time-signal intensity curves of the lesions have been evaluated. Chi square test, which is a non parametic test according to the BI-RADS measure, has been applied to the groups of phyllodes tumor and fibroadenoma. The consistency of the radiologic methods with evaluating the size of the lesions has been examined with Pearson correlation test. P<0.05 values have been accepted statistically meaningful. Results: It was determined that the average age of fibroadenoma cases was 43.00 and the average age of phyllodes tumor cases was 36.6. The location of the lesion was upper outer quadrant of the breast on the right side in these two tumor groups. In MG and US the shape of the lesion was oval in fibroadenoma group and it was lobular in phyllodes tumor group (p<0.05). In MG and US margin characteristics of the mass was sharp in fibroadenoma cases while it was microlobular in phyllodes tumor cases (p<0.001). It was evaluated that US eco structures were homogenous hypoechoic in fibroadenoma group while they were complex due to cystic changes and heterogenity (p<0.001). The size of the lesion was between 0 and 2 cm in fibroadenoma group while it was between 3 and 4 cm in phyllodes tumor group (p<0.001). Thanks to Color Doppler US, hypovascularity in fibroadenoma group and hypervascularity in phyllodes tumor cases were detected (p<0.001). As a result of the categorization made according to BI-RADS measure, BI-RADS were 3 in fibroadenoma group and BI-RADS were 4 in phyllodes tumor group (p<0.001). No difference between these two groups was detected due to small number of cases evaluated with MR. Conclusions: Preoperative MG, US and MR have made significant contributions to diagnosis of fibroadenoma and phyllodes tumor cases which are radiologically confused with each other and whose treatment methods are completely different and to differentiation of these two kinds of tumor.