Can Radiologist and Pathologist Reach The Truth Together in The Diagnosis of Benign Fibroepithelial Lesions?

Abstract

Objective: Benign fibroepithelial lesions (BFL) lesions of the breast are various and predominantly benign, although a few can be locally aggressive. Definitive diagnosis of some BFL can be challenging from core needle biopsy (CNB). Radiological findings can help guide the management of the lesions. The aim of this study was to investigate the accuracy rate of CNB results and evaluate the radiological findings of the most common BFL according to the final excision pathology results. The secondary aim was to assess the contribution of the imaging findings to CNB results. Materials and Methods: A retrospective review was made of 266 patients diagnosed with suspicious BFL, conventional fibroadenoma, complex fibroadenoma, cellular fibroadenoma and benign phyllodes tumor (PT). The study included 132 patients who underwent surgical excision. The radiological and histopathological findings were evaluated. Results: While 66 patients were diagnosed with more descriptive results on CNB, the other 66 patients were diagnosed with suspicious BFL. Agreement between CNB and excisional pathology was good, when CNB provided a definite diagnosis. While conventional and complex fibroadenoma were observed to have hypo or normal vascularity, cellular fibroadenoma and PT showed hypervascularity. Oval shaped and homogeneous internal echo pattern were significantly associated with conventional fibroadenoma. A heterogeneous internal echo pattern was seen in complex fibroadenomas and PT. Conclusion: CNB often reaches the correct diagnosis alone when it gives a definite diagnosis. The radiological findings which help in the differentiation of BFL are hypervascularity, oval shape and internal heterogeneity. More accurate results can be obtained when histopathological and radiological findings are evaluated together.