How is Phyllodes tumor diagnosed?

How is Phyllodes Tumor Diagnosed?

Phyllodes tumors are rare fibroepithelial breast tumors that account for less than 1% of all breast tumors. They are typically found in women in their 40s, although they can occur at any age. Phyllodes tumors are characterized by their leaf-like growth pattern and can be either benign (non-cancerous), borderline, or malignant (cancerous).

Diagnosing a phyllodes tumor involves a combination of clinical evaluation, imaging tests, and histopathological examination. The process aims to determine the nature of the tumor, its size, and whether it is benign or malignant.

Clinical Evaluation

The first step in diagnosing a phyllodes tumor is a thorough clinical evaluation. This involves a detailed medical history review and a physical examination of the breasts. During the physical examination, the healthcare provider will assess the size, shape, and texture of the breast, as well as check for any lumps or abnormalities.

Imaging Tests

After the clinical evaluation, imaging tests are often performed to further evaluate the tumor. The most commonly used imaging technique is mammography, which uses low-dose X-rays to create detailed images of the breast tissue. Mammograms can help identify the presence of a mass or abnormality in the breast.

Ultrasound is another imaging test that may be used to evaluate phyllodes tumors. It uses sound waves to create images of the breast tissue. Ultrasound can help determine the size, shape, and characteristics of the tumor, such as whether it is solid or fluid-filled.

In some cases, magnetic resonance imaging (MRI) may be recommended. MRI provides detailed images of the breast tissue using a combination of magnetic fields and radio waves. It can help assess the extent of the tumor and its relationship to surrounding structures.

Biopsy

A biopsy is the definitive diagnostic procedure for phyllodes tumors. It involves the removal of a small sample of tissue from the tumor for examination under a microscope. There are different types of biopsies that can be performed:

• Core Needle Biopsy: This procedure involves using a hollow needle to extract a small tissue sample from the tumor. The sample is then sent to a pathologist for analysis.


• Incisional Biopsy: In an incisional biopsy, a surgeon removes a portion of the tumor for examination. This type of biopsy is usually performed when the tumor is large.


• Excisional Biopsy: An excisional biopsy involves the complete removal of the tumor. This is typically done when the tumor is small and the suspicion of malignancy is high.

The biopsy sample is sent to a pathology laboratory, where a pathologist examines the tissue under a microscope. They assess the cellular characteristics of the tumor and determine whether it is benign, borderline, or malignant.

Histopathological Examination

The histopathological examination of the biopsy sample plays a crucial role in diagnosing phyllodes tumors. The pathologist examines the tissue for specific features, including the stromal cellularity, stromal overgrowth, and presence of atypia. These features help determine the tumor's grade and guide treatment decisions.

If the tumor is benign, it is classified as a benign phyllodes tumor. If the tumor shows some atypical features but does not meet the criteria for malignancy, it is classified as a borderline phyllodes tumor. If the tumor exhibits malignant characteristics, it is classified as a malignant phyllodes tumor.

Additional Tests

In some cases, additional tests may be performed to assess the extent of the tumor and determine if it has spread to other parts of the body. These tests may include:

• Computed Tomography (CT) Scan: CT scans use X-rays to create detailed cross-sectional images of the body. They can help identify any metastasis or spread of the tumor to other organs.


• PET-CT Scan: Positron Emission Tomography (PET) combined with CT can provide information about the metabolic activity of the tumor and detect any distant metastasis.

It is important to note that the diagnosis of a phyllodes tumor requires a multidisciplinary approach involving radiologists, pathologists, and breast surgeons. The combination of clinical evaluation, imaging tests, and histopathological examination allows for an accurate diagnosis and appropriate management of phyllodes tumors.