Differentiation Between Phyllodes Tumor and Fibroadenoma Using Real-Time Elastography

Abstract

Purpose: Phyllodes tumors (PT) are a rare entity accounting for less than 1 % of all breast lesions. They have a malignancy rate of 25 – 30 %. Differentiation from benign fibroadenomas is difficult using ultrasound, mammogram and MRI. The elastic characteristics of both tumors were examined using real-time elastography (RTE) to find specific patterns that make differentiation possible.

Materials and Methods: From February 2007 to May 2009, a total of 620 women were examined by RTE. Histological diagnosis was achieved using core needle biopsy. 123 of the lesions were fibroadenomas, 8 were phyllodes tumors. All patients underwent mammography and ultrasound followed by RTE. Sonography was performed by Acuson Antares, Premium Edition^® (Siemens, Erlangen, Germany) with a 7 and 10 MHz transducer.

Results: All phyllodes tumors had a similar elastic pattern with an elastic center and inelastic outer limits, referred to as the “ring sign”. It was found in 5 % of all fibroadenomas.

Conclusion: RTE provides a specific elastic pattern, which is sufficient for differentiating between a fibroadenoma and a phyllodes tumor. Therefore, the detection of the most suspicious lesion in women with the coexistence of multiple fibroadenomas and phyllodes tumors seems easier.

Zusammenfassung

Ziel: Phylloides-Tumoren zählen zu den seltenen Brusttumoren und haben in 25 – 30 % ein malignes Potential. Die Unterscheidung zwischen Phylloides-Tumor und Fibroadenom ist mit Ultraschall, Mammografie und MRT nicht eindeutig möglich. Ziel war es daher, die Eigenschaften beider Tumortypen in der Real-time-Elastografie (RTE) zu untersuchen und herauszufinden, ob es ein charakteristisches Bildmuster gibt, welches die Differenzierung beider Tumortypen erlaubt.

Material und Methoden: Zwischen Februar 2007 und Mai 2009 wurden 620 Frauen mittels Mammografie, Sonografie und RTE untersucht. Bei 450 von ihnen wurde eine Histologie mittels Stanzbiopsie gewonnen, welche 123 Fibroadenome und 8 Phylloides-Tumoren ergab. Die Sonografie und RTE wurden mit einem 7 und 10 MHz Schallkopf an einem Acuson Antares, Premium Edition^® Ultraschallgerät (Siemens, Erlangen, Deutschland) durchgeführt.

Ergebnisse: Alle Phylloides-Tumoren hatten das gleiche Bildmuster in der RTE mit einem elastischen Kern und einem unelastischen Halo. Dies wurde als „Ringzeichen“ tituliert. Es wurde auch in 5 % aller Fibroadenome nachgewiesen.

Schlussfolgerung: Phylloides-Tumoren haben in der RTE ein charkteristisches Bildmuster, welches die Differenzierung zu Fibroadenomen ermöglicht. Speziell bei Frauen, bei denen neben einem Phylloides-Tumor gleichzeitig mehrere Fibroadenome nachweisbar sind, hilft die RTE bei der Auswahl einer geeigneten Läsion für eine Stanzbiopsie.

Key words

fibroadenoma - phyllodes tumor - elastography - breast

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