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Differentiation between phyllodes tumor and fibroadenoma using real-time elastography.

B R Adamietz1, L Kahmann, P A Fasching

  • 1Diagnostische Radiologie, Universität Erlangen, Erlangen, Germany. boris.adamietz@uk-erlangen.de

Ultraschall in Der Medizin (Stuttgart, Germany : 1980)
|December 24, 2011
PubMed
Summary

Real-time elastography (RTE) can differentiate rare phyllodes tumors from common fibroadenomas. Phyllodes tumors show a distinct "ring sign" on RTE, aiding diagnosis in breast lesions.

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Area of Science:

  • Radiology
  • Oncology
  • Pathology

Background:

  • Phyllodes tumors (PT) are rare breast lesions, comprising <1% of all breast tumors.
  • PTs have a significant malignancy rate (25-30%), necessitating accurate differentiation from benign fibroadenomas.
  • Distinguishing PTs from fibroadenomas using conventional imaging like ultrasound, mammography, and MRI is challenging.

Purpose of the Study:

  • To investigate the elastic characteristics of phyllodes tumors and fibroadenomas using real-time elastography (RTE).
  • To identify specific elastographic patterns that enable differentiation between PTs and fibroadenomas.
  • To assess the utility of RTE in diagnosing breast lesions.

Main Methods:

  • A total of 620 women were examined using RTE between February 2007 and May 2009.
  • Histological diagnosis was confirmed via core needle biopsy for 123 fibroadenomas and 8 phyllodes tumors.
  • All patients underwent mammography and ultrasound prior to RTE, with sonography performed using specific Siemens equipment and transducers.

Main Results:

  • All phyllodes tumors exhibited a consistent elastic pattern characterized by an elastic center and inelastic outer limits, termed the "ring sign".
  • This specific "ring sign" pattern was observed in only 5% of the examined fibroadenomas.
  • RTE demonstrated a distinct elastographic signature for phyllodes tumors.

Conclusions:

  • Real-time elastography provides a specific elastic pattern sufficient for differentiating between fibroadenomas and phyllodes tumors.
  • The "ring sign" identified via RTE aids in the detection of suspicious lesions, particularly when multiple fibroadenomas and phyllodes tumors coexist.
  • RTE enhances diagnostic accuracy for challenging breast lesions.