Fibroadenoma Research Articles

287 Retrospective Review of a Single Surgeon 5-Year Experience of Paediatric Breast Reconstruction - Challenges, Experience, and the Increasing Role of Lipofilling

Abstract Aim This case series reviews the presentation, clinical and surgical management of paediatric breast cases undertaken by a single surgeon. The series demonstrates the powerful role of lipomodelling when used with breast reshaping techniques to achieve good outcomes and avoid the need to commit young patients to breast implants. Method Retrospective analysis of paediatric breast referrals to a single surgeon at a regional plastic surgery breast reconstruction unit over a 5-year period. Results In a 5-year period, 15 cases which presented in childhood to a tertiary paediatric centre were referred on to our regional plastic surgery breast reconstruction unit. Two patients underwent correction of breast hypoplasia secondary to Poland's syndrome. Nine patients presented for breast asymmetry with associated tuberous deformity. One patient had maldevelopment of a breast secondary to a burn's contracture. Two patients presented with gigantomastia and one patient with juvenile fibroadenomas. Conclusions Paediatric breast abnormalities represent a small but important caseload for a breast reconstructive surgeon. This case series demonstrates the need for careful assessment and an individualised surgical plan for each patient. The surgical plan must achieve a satisfactory outcome whilst minimising the need for further procedures as the patient grows. It is the senior surgeon's preference to avoid breast implant-based reconstruction where possible. In all but one case lipomodelling combined with reshaping of the native tissue was used to good effect.

Identification of Immune Cell Components in Breast Tissues by a Multiparametric Flow Cytometry Approach.

Simple SummaryThe tumor microenvironment in breast cancer plays important roles in tumor development and treatment response, giving important information critical for disease management. Today, an analysis of the tumor microenvironment is included in routine histopathologic reporting for practical clinical application. This manuscript aimed to deepen the study of the tumor microenvironment, analyzing the immune cells in breast tumoral and benign pathologies. Indeed, using a deep immunophenotyping approach by flow cytometry, we have studied the immune cells at the level of breast tissues, identifying different immunophenotyping that could be useful in the diagnosis and follow up of breast pathologies. As possible targets are continually being discovered in the tumor microenvironment, a future approach to breast cancer diagnosis and therapy could likely combine cancer cell elimination and tumor microenvironment modulation.Immune cell components are able to infiltrate tumor tissues, and different reports described the presence of infiltrating immune cells (TILs) in several types of solid tumors, including breast cancer. The primary immune cell component cells are reported as a lymphocyte population mainly comprising the cytotoxic (CD8+) T cells, with varying proportions of helper (CD4+) T cells and CD19+ B cells, and rarely NK cells. In clinical practice, an expert pathologist commonly detects TILs areas in hematoxylin and eosin (H&E)-stained histological slides via light microscopy. Moreover, other more in-depth approaches could be used to better define the immunological component associated with tumor tissues. Using a multiparametric flow cytometry approach, we have studied the immune cells obtained from breast tumor tissues compared to benign breast pathologies. A detailed evaluation of immune cell components was performed on 15 and 14 biopsies obtained from breast cancer and fibroadenoma subjects, respectively. The percentage of tumor-infiltrating T lymphocytes was significantly higher in breast cancer patients compared to patients with fibroadenoma. Infiltrating helper T lymphocytes were increased in the case of malignant breast lesions, while cytotoxic T lymphocytes disclosed an opposite trend. In addition, our data suggest that the synergistic effect of the presence/activation of NK cells and NKT cells, in line with the data in the literature, determines the dampening of the immune response. Moreover, the lymphocyte-to-monocyte ratio was calculated and was completely altered in patients with breast cancer. Our approach could be a potent prognostic factor to be used in diagnostic/therapeutic purposes for the improvement of breast cancer patients’ management.

Peculiarities of neoplasms appeared after total body irradiation and homeostasis parameters in rats

Background: Tissue damage and disruption of metabolic processes as a result of total body irradiation (TBI) could lead to tumorigenesis. Methods: Female rats (25 of 32) were X-irradiated with a 6-Gy dose. On month 12±1 animals were sacrificed. The alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), amylase, lactate dehydrogenase (LDH), Ca 2+, creatinine, glucose, phosphorus, urea, uric acid, total protein, pO2, pCO2, pH, and blood cell count were evaluated in blood. Tumors were examinated histologically. Results: On 12±1 months after TBI, 76% of rats had visually detected tumors, histologically classified as benign fibro adenomas. Metabolic, hematological changes versus healthy control indicated disturbances in the homeostasis system. The blood lactate level was typically higher in animals with tumors than without. The ratio of tumor weight to lactate (or LDH) level in blood was 1±0.5 in the 63% of rats and histological analysis revealed the signs of biphasic hyperplasia of glandular lobes and connective tissue stroma, associated with secretory and proliferative activities in tumor. In animals with high values of this ratio (≥1.5) neoplasms were represented by fibrous and glandular tissues presenting a predominant stromal fibrous component, associated with the prevalence of high proliferation in tumor. While in 20% of tumor bearing rats with the low ratio (<0.5) predominated an epithelial structure with homogeneous basophilic content in the glandular lumens, suggesting the domination of secretory activity in tumor. Conclusions: TBI promoted the alterations of hematological and biochemical parameters of homeostasis in rats and provoked the appearance of benign tumors one year after. The ratio of tumor mass to lactate (or LDH) level in blood seems to be an informative indicator of the histological particularities of tumors, suggesting the prevalence of proliferative or secretory activity, or the balance between them.

The interaction between the soluble programmed death ligand-1 (sPD-L1) and PD-1+ regulator B cells mediates immunosuppression in triple-negative breast cancer.

Accumulating evidence suggests that regulatory B cells (Bregs) play important roles in inhibiting the immune response in tumors. Programmed death 1 (PD-1) and programmed death ligand 1 (PD-L1) are important molecules that maintain the balance of the immune response and immune tolerance. This study aims to evaluate the soluble form of PD-L1 and its function in inducing the differentiation of B lymphocytes, investigate the relationship between soluble PD-L1 (sPD-L1) and B-cell subsets, and explore the antitumor activity of T lymphocytes after PD-L1 blockade in coculture systems. In an effort to explore the role of sPD-L1 in human breast cancer etiology, we examined the levels of sPD-L1 and interleukin-10 (IL-10) in the serum of breast tumor patients and the proportions of B cells, PD-1+ B cells, Bregs, and PD-1+ Bregs in the peripheral blood of patients with breast tumors and assessed their relationship among sPD-L1, IL-10, and B-cell subsets. The levels of sPD-L1 and IL-10 in serum were found to be significantly higher in invasive breast cancer (IBCa) patients than in breast fibroadenoma (FIBma) patients. Meanwhile, the proportions and absolute numbers of Bregs and PD-1+ Bregs in the peripheral blood of IBCa patients were significantly higher than those of FIBma patients. Notably, they were the highest in triple-negative breast cancer (TNBC) among other subtypes of IBCa. Positive correlations of sPD-L1 and IL-10, IL-10 and PD-1+ Bregs, and also sPD-L1 and PD-1+ Bregs were observed in IBCa. We further demonstrated that sPD-L1 could induce Breg differentiation, IL-10 secretion, and IL-10 mRNA expression in a dose-dependent manner in vitro. Finally, the induction of regulatory T cells (Tregs) by Bregs was further shown to suppress the antitumor response and that PD-L1 blockade therapies could promote the apoptosis of tumor cells. Together, these results indicated that sPD-L1 could mediate the differentiation of Bregs, expand CD4+ Tregs and weaken the antitumor activity of CD4+ T cells. PD-L1/PD-1 blockade therapies might be a powerful therapeutic strategy for IBCa patients, particularly for TNBC patients with high level of PD-1+ Bregs.

A Study to Assess the Effectiveness Educational Module on Breast Self-Examination in Terms of Knowledge and Skills Among Girls of Government Pre-University College at Bagalkot

Introduction: Defining ideal breast shape is one of the most fundamental and essential. it has been regarded as a symbol of beauty, sexuality and motherhood. Breast diseases are very common and can be found in most women. Among the diseases of the breast, majority of the lesions are benign (non cancerous). This occurs due to various reasons such as infection, trauma, fibro adenoma, cyst or fibrocystic condition of breast. Even so, a woman who detects a breast lump should have it evaluated as soon as possible. Breast self- examination is most important skill in prevention of breast cancer and by performing it. Regularly women can save themselves from getting this disease and death can prevent too. It is very simple requires no instruments and easily performed by every woman. Early. There is high mortality due to late stage diagnosis of breast diseases as patients usually present at an advanced stage because of lack of awareness and nonexistent breast cancer screening programme. Aims: The aims of study are as follows: (1) To assess the existing knowledge and skills regarding breast self-examination among adolescent girls of Government Pre-University collage at Bagalkot. (2) To determine the effectiveness of educational module regarding breast self- examination among adolescents girls of Government Pre-University collage at Bagalkot.(3) To correlate post-test knowledge and skills level regarding breast self examination among adolescent girls of Government Pre-University collage at Bagalkot. (4) To find out the association between post-test knowledge level and skills regarding breast self-examination among adolescent girls with their selected socio- demographic variables. Materials and Methods: Study approach this was a qualitative study and follow the examination plan as pre-exploratory, for example one gathering pre –test and post –test without control group. The population associated with this investigation was adolescent girls studying at government pre-university college at Bagalkot. Test size is 50 (Total) adolescent girls were redeemed for the investigation. Further information were gathered by organized shut finished information poll. Results: The knowledge level of the students regarding breast self-examination showed that in pre test scores, majority (80%) of the sample had average knowledge, 20% had good knowledge and none of them had very good knowledge on breast self- examination where as in post test score all of them had very good knowledge on breast self-examination. The skill level of students regarding breast self-examination showed that in pre test score, majority (73.33%) of the sample had average level of performance, 23.33% had below average and only 3.33% had good level of performance on breast self-examination where as in post test all of them had good level of performance on breast self-examination. There was a mild positive and significant correlation between level of knowledge and skill scores of students on breast self-examination (r(28) = 0.783; p<0.05). The study also found that the post test knowledge and skill score was not significantly associated with any of the demographic variables under study. Keywords: Breast self-examination, Adolescent girls, Educational module, Knowledge, Skills, Adolescent.

The value of whole-tumor histogram and texture analysis based on apparent diffusion coefficient (ADC) maps for the discrimination of breast fibroepithelial lesions: corresponds to clinical management decisions.

This study aims to comprehensively evaluate the diagnostic value of quantitative parameters extracted from apparent diffusion coefficient (ADC) maps in distinguishing fibroepithelial tumors using whole-tumor histogram and texture analysis. This retrospective study included 66 female patients with single phyllodes tumor (PT) and 29 female patients with single fibroadenoma (FA) who underwent preoperative magnetic resonance imaging. By independently performing whole-tumor histogram and texture analysis based on ADC maps, two radiologists extracted seven histogram parameters and four texture parameters. The extracted parameters were compared using univariate analysis to determine their ability to distinguish FAs from PTs, benign PTs from FAs, as well as benign PTs from borderline and malignant PTs. When FAs and PTs were compared, ADC_skewness values of PTs were significantly lower than those of FAs (p < 0.05), whereas other significant extracted parameter values of PTs were significantly higher than those of FAs (p ≤ 0.001); the area under the curve of significant parameters combined was 0.936. Regarding the differences between FAs and benign PTs, ADC_SD, ADC_95th percentile and ADC_kurtosis of FAs were significantly lower than those of benign PT group, and ADC_skewness was higher than that of benign PT group (all p < 0.05). Furthermore, ADC_SD, ADC_95th percentile and all texture parameters are significantly higher in the borderline and malignant PT group than in FA and benign PT group (p < 0.05). In addition, ADC_kurtosis of malignant PT group was significantly lower than that of borderline PT group (p = 0.045). The extracted whole-tumor histogram and texture features of ADC maps can improve differential diagnosis of breast fibroepithelial tumors and contribute to optimal selection for clinical management of patients with fibroepithelial tumors.

Diagnostic approach to fibroepithelial tumors of the breast

Fibroepithelial tumors of the breast are a heterogeneous group of mixed lesions with an epithelial and a stromal component. The diagnostic spectrum ranges from the benign variant of fibroadenoma to the phyllodes tumor in its benign, borderline, and malignant forms. These lesions are sometimes difficult to diagnose, especially distinguishing between a cellular fibroadenoma and a benign phyllodes tumor. In both phyllodes tumor and fibroadenoma, the differential diagnosis with other breast lesions, benign and malignant, must be established. The treatment surgery and the prognosis, in the case of phyllodes tumors, will depend on their pathological characteristics.

Evaluation of high-risk patients with dense breast on high-resolution ultrasound for screening and detection of breast cancer where mammography is of low significance

Abstract Background: Early diagnosis of breast cancer is a challenging problem in high-risk patients with dense breast. The risk of breast cancer is many fold higher in dense breast as compared to nondense on one side with limited screening or diagnostic role of mammography on the other side. The aim of our study is to elaborate the role of high-resolution ultrasonography (HR-USG) as adjunct modality to overcome this limitation. Materials and Methods: This is a prospective observational study conducted in the breast care clinic of a tertiary care cancer hospital. Totally, 2720 patients were enrolled for mammography. Out of these, 339 patients were reported according to Breast Imaging Reporting and Data System (BIRADS) as 0 (inconclusive) and were suggested for further evaluation by other modalities. All patients reported for mammography as BIRADS 0, were included in this study for HR-USG. Results: On HR-USG, 33.4% of patients with dense breast were shown to have suspicious (BIRADS 5) lesions. 21.7% had simple cysts. Fibro adenomas and abscess were seen in 18% and in 15% of patients, respectively. Other findings were duct ectasia (4.3%) and galactocele (3.4%). 1.4% of patients were normal on HR-USG. Conclusion: Our study showed HR-USG as a modality of choice that supersedes the diagnostic efficiency of mammography in patients with dense breasts thus enhances early detection and better treatment of breast cancer, decreasing mortality owning to delay in diagnosis.

Prevalence of breast fibroadenoma in healthy physical examination population in Guangdong province of China: a cross-sectional study

ObjectiveTo provide an accurate assessment of the prevalence of breast fibroadenoma in a large population and to confirm the diagnostic accuracy of ultrasound for fibroadenoma.DesignThis was a cross-sectional survey.SettingThis research...

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

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 3cm in size is justified. 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. 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 56months; 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 38.3mm. 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.

Dosimetric analysis of ultrasound-guided high intensity focused ultrasound ablation for breast fibroadenomas: a retrospective study

Objective To investigate the factors influencing the sonication dosage and efficiency of ultrasound-guided high intensity focused ultrasound (USgHIFU) for breast fibroadenomas. Materials and Methods Forty-nine patients with 78 breast fibroadenomas who underwent USgHIFU were retrospectively analyzed. The energy efficiency factor (EEF) was set as dependent variable, and the factors possibly influencing the sonication dosage, including age, body mass index (BMI), fibroadenoma size, distance from the shallow margin of the fibroadenoma to skin, distance from the deep margin of the fibroadenoma to pectoralis major, types of near field acoustic pathway, and Adler blood flow classification of ultrasound, were set as independent variables. The correlation between EEF and these independent variables were analyzed, and an optimal scaling regression model was established. Results Fibroadenoma size, distance from the shallow margin of the fibroadenoma to skin and type of near field acoustic pathway had significant correlation with EEF (p < 0.05). An EEF (ŷ) dosimetry model of ŷ= −0.496X1 + 0.287X2 + 0.203X3 was established, in which X1 stands for size of fibroadenoma, X2 stands for the distance from shallow margin of the fibroadenoma to skin, and X3 stands for type of near field acoustic pathway. The predicted EEF value was significantly related to actual EEF (R = 0.698, p = 0.000). Conclusions Fibroadenoma size, distance from the shallow margin of the fibroadenoma to skin and type of near field acoustic pathway could be used as predictors to evaluate the dosage delivery of USgHIFU treatment for breast fibroadenomas.

Computer-Aided Detection of Quantitative Signatures for Breast Fibroepithelial Tumors Using Label-Free Multi-Photon Imaging.

Fibroadenomas (FAs) and phyllodes tumors (PTs) are major benign breast tumors, pathologically classified as fibroepithelial tumors. Although the clinical management of PTs differs from FAs, distinction by core needle biopsy diagnoses is still challenging. Here, a combined technique of label-free imaging with multi-photon microscopy and artificial intelligence was applied to detect quantitative signatures that differentiate fibroepithelial lesions. Multi-photon excited autofluorescence and second harmonic generation (SHG) signals were detected in tissue sections. A pixel-wise semantic segmentation method using a deep learning framework was used to separate epithelial and stromal regions automatically. The epithelial to stromal area ratio and the collagen SHG signal strength were investigated for their ability to distinguish fibroepithelial lesions. An image segmentation analysis with a pixel-wise semantic segmentation framework using a deep convolutional neural network showed the accurate separation of epithelial and stromal regions. A further investigation, to determine if scoring the epithelial to stromal area ratio and the SHG signal strength within the stromal area could be a marker for differentiating fibroepithelial tumors, showed accurate classification. Therefore, molecular and morphological changes, detected through the assistance of computational and label-free multi-photon imaging techniques, enable us to propose quantitative signatures for epithelial and stromal alterations in breast tissues.

Evaluation of Cytomorphological Patterns of Fibroadenoma on Cytology: Emphasis on Pattern based approach to avoid misdiagnosis

Background: Fibroadenoma (FA) is a frequently occurring breast lesion diagnosed on fine needle aspiration cytology (FNAC) with a bimodal picture comprising of epithelial and/or stromal component. It can have a gamut of differential diagnosis depending on the predominant cellular features reflected on cytological smears, thereby it is important that the cytologist should be well versed with the various patterns of fibroadenoma to avoid diagnostic errors. Materials and methods: The present study was conducted over a period of two years including all cases of fibroadenoma diagnosed on cytology (n=234). The detailed cytomorphological spectrum was analysed to study the different patterns of fibroadenoma on cytology. Out of these (234), cytohistological correlation was performed in 197 cases. Results: The incidence of fibroadenoma among all the breast FNACs was 50% (234/468). The different patterns observed were: epithelial predominant, stromal predominant, FA with giant cells, apocrine change, cyst macrophages, granuloma, acute inflammation and atypia. Cytohistologic concordance was observed in 173/197 cases (87.8%). Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 98.8%, 92.3%, 87.8%, 94.5% and 88.8% respectively. Conclusion: Although fibroadenoma can be diagnosed with ease on cytology in most of the cases, However, at times in addition to classical features, morphological variations are observed such as giant cells, cyst macrophages, apocrine change, granulomas, acute inflammation and atypia wherein it maybe misdiagnosed as benign phyllodes, hyperplasia, fibrocystic disease etc.. This pattern based approach for the cytological diagnosis of FA is re-emphasized in the index article so as to create awareness about these varied patterns among the young cytopathologists. Bangladesh Journal of Medical Science Vol. 21 No. 03 July’22 Page: 590-595

A Rare Case of Fibroadenoma in an Accessory Breast over Anterior Chest Wall

Accessory breast tissue is an uncommon condition which occurs in 0.4–6% of women. It is mostly located in the axilla where it can cause diagnostic difficulty, especially if it is unilateral and large. Usually it is bilateral and presents as an asymptomatic mass during pregnancy or lactation. The diagnosis of ectopic breast tissue is important as it can undergo the same pathological changes that occur in a normal breast, such as mastitis, fibrocystic disease and carcinoma. We present a case of unilateral accessory breast without nipple and areola over anterior chest wall with a fibroadenoma inside it in a 20 year old lady.

AB173. SOH22ABS202. Juvenile fibroadenoma management: a retrospective case series in a tertiary hospital

AB173. SOH22ABS202. Juvenile fibroadenoma management: a retrospective case series in a tertiary hospital

Periareolar Incision for Resection of Bilateral Multiple Breast Fibroadenoma in 27-year-old Indonesian Woman – A Case Report

Introduction: A Breast lump is a major health concern amongst women and Fibroadenoma (FA) is the second most common tumor in the breast and is the most common tumor in women younger than 30 years and only surgical resection is curative. The conventional surgical excision is through an overlying incision of the mass and then developed another incision location due to cosmesis concern which is through a periareolar incision.&#x0D; Case Presentation: 27-year-old woman with painless slowly growing bilateral multiple breast lump for 1 year. On physical examination we found bilateral multiple solid masses, with 6 masses on the lateral inferior quadrant, lateral superior quadrant, medial superior quadrant on the right breast, and 4 masses on the same quadrant of the left breast, well-circumscribed, mobile. From the ultrasound, we found well-defined echogenic thin-walled masses suggesting fibroadenoma. We perform multiple excision from the bilateral periareolar incisions.&#x0D; Discussion: Periareolar incision leaves less scar and better cosmetic resulted in higher satisfaction level among women. We found no complications such as nipple paresthesia, the collapse of the nipple-areola area, hematoma, skin necrosis with only 5 ccs of bleeding, and duration of the surgery same as conventional incision.&#x0D; Conclusion: Periareolar incision for removal of the bilateral multiple FA is a favorable technique and recommended.

A comparative study between the efficacy of bupivacaine plus nalbuphine versus bupivacaine alone in pectoral nerve block for management of postoperative pain in patients undergoing breast fibroadenoma excision

BackgroundBreast surgeries, even the relatively minor ones, can be associated with significant postoperative pain affecting patients’ physical and psychological well-being. As a result, regional anaesthetic approaches have been used for breast surgery anaesthesia and analgesia. PECS I and II blocks have been proven to be relatively easy and safe in such regards. Moreover, using adjuvants, such as nalbuphine, have been proposed by many studies to intensify the block and decrease postoperative analgesic intake.This current study aims to assess the effects of using nalbuphine (20 mg) as a bupivacaine 0.25% (10 ml) adjuvant in PECS I block compared to injecting bupivacaine 0.25% (10 ml) alone in fibroadenoma excision patients.This trial enrolled 60 patients, 30 of whom received bupivacaine plus nalbuphine (group BN) and 30 in the bupivacaine only (group B). Postoperative VAS, SpO2 and vital signs at 0, 1, 2, 4, 6, 12 and 24 h as well as the amount of morphine consumed, the time it took for the first analgesic to be administered and adverse effects were both recorded and compared.ResultsRegarding postoperative outcomes, a statistically significant difference between the two groups was not detected regarding VAS, SpO2, vital signs and adverse effects. Similarly, there was no statistically significant difference in total morphine intake in the 24 h following surgery between the two groups (p-value = 0.65). Only 9 out of 60 patients needed analgesia, 5 in the BN group and 4 in the B group, and time to the first analgesic was not of statistically significant difference between BN and B groups (211.8 ± 71.29 and 183.5 ± 29.872 min respectively) (p-value = 0.73). In terms of postoperative complications, there was no statistically significant difference between the two groups.ConclusionsAdding nalbuphine (20 mg) to bupivacaine in PECS I block in fibroadenoma patients undergoing excision is not accompanied by a difference with statistical significance in postoperative VAS, morphine consumption and duration to the first analgesia when compared to bupivacaine alone.

Cellular fibroadenoma versus phyllodes tumors: A pre-operative diagnostic approach based on radiological and cytological features.

This study has been designed in an effort to identify the clinico-radiological and cytological features that could effectively help in differentiating cellular fibroadenoma (CFA) and phyllodes tumors (PT), which have several overlapping characteristics. Histologically proven cases of CFA and PT were reviewed. Cytological features were assessed and categorized. Clinical and radiological details were also evaluated and he the two groups were compared statistically. A total of 43 FA and 52 PT were specimens were reviewed. Mean age and tumor size for CFA and PT were 26.05 and 36.94 years, and 3.7 and 6.4cm, respectively. Univariate analysis and regression models revealed that age >30 years, BIRADS grade of 4 or more, marked cellularity of stromal fragments, more than 30% spindle cells in background cell population and presence of traversing blood vessels in stromal fragments increased the odds of a tumor being phyllodes. The binary logistic regression model was able to predict PT accurately in 87.2% cases (p < .001). PT and CFA could be differentiated if cytological findings are cautiously correlated clinically and radiologically. Age, BIRADS category along with assessment of stromal fragments and background population can effectively distinguish between CFA and PT.

Value of Histogram of Gray-Scale Ultrasound Image in Differential Diagnosis of Small Triple Negative Breast Invasive Ductal Carcinoma and Fibroadenoma.

ObjectiveTo investigate the value of gray-scale ultrasound (US) image histogram in the differential diagnosis between small (≤2.00 cm), oval, or round triple negative breast invasive ductal carcinoma (TN-IDC) and fibroadenoma (FA).MethodsFifty-five cases of triple negative breast invasive ductal carcinoma (TN-IDC group) and 57 cases of breast fibroadenoma (FA group) confirmed by pathology in Hubei cancer hospital from September 2017 to September 2021 were analyzed retrospectively. The gray-scale US images were analyzed by histogram analysis method, from which some parameters (including mean, variance, skewness, kurtosis and 1st, 10th, 50th, 90th and 99th percentile) can be obtained. Intraclass correlation coefficient (ICC) was used to evaluate the inter observer reliability of histogram parameters. Histogram parameters between the TN-IDC and FA groups were compared using independent Student’s t-test or Mann-Whitney U-test, respectively. In addition, the receiver operating characteristic (ROC) curve analysis was used for the significant parameters to calculate the differential diagnosis efficiency.ResultsAll the histogram parameters showed excellent inter-reader consistency, with the ICC values ranged from 0.883 to 0.999. The mean value, 1st, 10th, 50th, 90th and 99th percentiles of TN-IDC group were significantly lower than those of FA group (P < 0.05). The area under ROC curve (AUC) values of mean and n percentiles were from 0.807 to 0.848. However, there were no significant differences in variance, skewness and kurtosis between the two groups (P > 0.05).ConclusionHistogram analysis of gray-scale US images can well distinguish small, oval, or round TN-IDC from FA.

Assessment of Stromal Elastin Fibers in Breast Cancer and Fibroadenomas: Is There a Correlation With Ultrasound Elastography Findings?

The stiffness of a breast lesion provides information on the likelihood of malignancy. The most important factor affecting this stiffness is the composition of the extracellular matrix (ECM). The aim of this study was to assess the elastin fiber contents of malignant breast lesions and fibroadenomas and investigate any relationship between the shear wave velocity (SWV) measured by ultrasonography, and the elastin fiber content of lesions. Consecutive patients with breast lesions were enrolled. The SWV values of the lesions were analyzed. Histopathological analysis of elastin in excised lesions was performed by the method of Shivas and Douglas. Breast cancer patients were reviewed according to their lymph node status and tumor diameter. The relationship between SWV value and tissue elastin fiber score was analyzed. The correlation between breast cancer grade and elastin fiber score in malignant lesions was investigated. A total of 167 consecutive breast lesions in 167 patients were included in this study (75 invasive cancer, 92 fibroadenomas). High elastic fiber score was significantly more common (p = 0.001) in malignant lesions (n = 61; 81.3%) than fibroadenomas (n = 13; 14.1%). There was a negative correlation between the mean SWV and the elastin fiber score of fibroadenomas (p = 0.001). A low grade in breast cancer was associated with high elastin fiber score (p = 0.01). Malignant lesions tend to have higher elastin fiber scores than fibroadenomas. Elastin fiber assessment may provide additional prognostic information in malignant lesions. Changes in elastin fiber content may account for the variation in elasticity in fibroadenomas.