Clinical Diagnosis And Treatment Of 74 Patients With Breast Phyllodes Tumors

Objective:To explore the clinical diagnosis and treatment of breast phyllodes tumors with different pathological types.Methods:The 74 newly diagnosed female patients with breast phyllodes tumors admitted from 2008-08-01 to 2017-08-31 of our hospital were retrospectively analyzed,including 40 benign PT,25 borderline PT and 9malignant PT.All patients were divided into benign PT group and borderline/malignantPTgroup,theclinicalcharacteristics,imaging characteristics of Color doppler ultrasound,Mammography and MRI,biopsy methods and surgical methods were compared between the two groups;Chi-square test or exact probabilities was used for counting data;Imaging BI-RADS categories 4 and 5 were regarded as malignant result,and the diagnostic effects of Color doppler ultrasound,Mammography,MRI were evaluated by specificity,sensitivity and accuracy;ROC was used to compare the diagnostic efficacy of MRI function and morphology;Univariate analysis and COX multivariate analysis were used to explore the factors affecting DFS in patients.Results:Among the following clinical characteristics,the rate of benign PT group was higher than that of borderline/malignant PT group:Age?45?97.5%vs 55.9%?;Tumor diameter<5cm?52.5%vs 26.5%?;round or lobulated?77.5%vs 52.9%?;clear boundary?75.0%vs 47.1%?,P<0.05.Comparing three imaging diagnosis with pathological diagnosis,the diagnostic accuracy of Color doppler ultrasound was 60.6%,the misdiagnosis rate was 29.4%,the youden index was 0.206,and the Kappa coefficient was0.207.The diagnostic accuracy of Mammography was 58.1%,the misdiagnosis rate was 40.0%,the youden index was 0.165,and the Kappa coefficient was0.164.The diagnostic accuracy of MRI was 69.2%,the misdiagnosis rate was38.9%,the youden index was 0.373,and the Kappa coefficient was 0.376.Comparison of consistency between imaging diagnosis and pathological diagnosis was Mammography<Color doppler ultrasound<MRI.In MRI diagnosis,33.3%of benign PT were abnormal signals with homogeneous enhancement,66.7%TIC was ascending type,and 72.2%ADC value?1.5�10^-3mm²/s.100.0%borderline/malignant PT were abnormal signals with nonhomogeneous enhancement,42.9%TIC was platform type,33.3%TIC was outflow type,and 66.7%ADC value<1.5�10^-3mm²/s.?P<0.05?.The combined diagnosis of MRI functional parameters or the combined diagnosis of functional and morphological parameters were better than single morphological or functional parameters.Both AUC were 0.806?P=0.001?.Comparison of accuracy between different biopsy diagnosis and pathological diagnosis:Hollow needle biopsy?31.3%?<minimal invasion technique?33.3%?<rapid freezing pathology?50.0%?<tumor resection?80.0%?,P=0.078.Among the 74 cases of PT,local tumor resection accounted for 58.1%,expanded resection of tumor for 14.9%,and mastectomy for 27.0%.The local recurrence or metastasis rates were 11.6%,9.1%and 5.0%,respectively.P=0.857.The disease free survival rate and overall survival rate of the whole group were 90.5%and 100.0%respectively.The disease free survival rate of benign PT and borderline and malignant PT were 97.5%and 82.4%respectively.Pathological classification is an independent factor affecting DFS of breast phyllodes tumors,and borderline and malignant PT have worse prognosis than benign PT?P=0.025?.Conclusion:1.Clinical features and imaging features are of certain value in the diagnosis of PT,especially MRI functional examination of breast has high value in differentiating benign and malignant PT.2.The diagnosis accuracy of tumor resection and biopsy is the highest.3.In the case of negative surgical margin,benign PT is feasible for complete tumor resection;Borderline and malignant PT require expanded resection of tumor and total mastectomy if necessary.