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Spindle Cell Lesions of the Breast: A Diagnostic Algorithm
1From the Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
Archives of Pathology & Laboratory Medicine
|August 17, 2022
Summary
Breast spindle cell lesions range from benign to malignant, posing diagnostic challenges. This review classifies these lesions and proposes an algorithm using clinical, morphologic, and immunohistochemical features for accurate diagnosis.
Area of Science:
- Breast pathology
- Oncology
- Diagnostic challenges in breast lesions
Background:
- Spindle cell lesions of the breast encompass a wide range of conditions, from non-neoplastic to malignant.
- Their diverse nature presents significant diagnostic difficulties for clinicians.
Purpose of the Study:
- To review the classification of breast spindle cell lesions.
- To outline clinical features, morphology, and the utility of immunohistochemistry and molecular tools.
- To propose a diagnostic algorithm for differential diagnosis.
Main Methods:
- Literature review
- Analysis of personal experience
- Synthesis of diagnostic criteria
Main Results:
- Classification into biphasic (epithelial and spindle cell components) and monophasic (spindle cell only) categories.
- Subclassification into low-grade and high-grade lesions within each category.
- Identification of common and uncommon lesions in each subcategory, including fibroadenoma, phyllodes tumors, metaplastic carcinomas, and sarcomas.
Conclusions:
- Accurate classification relies on distinguishing biphasic and monophasic lesions, and low-grade versus high-grade types.
- Clinical history and detailed evaluation of epithelial differentiation using immunohistochemistry are critical.
- A proposed diagnostic algorithm aids in differentiating these complex breast lesions.
