| ObjectiveFibroepithelial tumors of the breast include the common fibroadenoma(FA)and the rare phyllodes tumor(PT).This tumor has a biphasic feature,that is,the tumor parenchyma consists of epithelial and stromal cells.In clinical practice,histological features of phyllodes tumor and fibroadenomas may overlap because they are of the same origin.At the same time,some benign phyllodes may not have typical phyllodes structure and obvious interstitial cell proliferation,so it is difficult to distinguish them.Compared with fibroadenoma,phyllodes tumor are at risk of local recurrence and distant metastasis,especially in malignant phyllodes tumor,which recurrence and metastasis are more common.Therefore,accurate diagnosis and pathological grading of phyllodes tumors are very important for patients.In our previous study,hyperprolactin was found to be associated with the occurrence of fibroepithelial tumors,suggesting that prolactin may be used as a potential serological diagnostic marker for phyllodes tumors.To collect the clinicopathologic characteristics of breast phyllodes tumor and breast fibroadenoma,we had analysised the following problems.Frist,to analysis the first pathological diagnosis of breast phyllodes tumor in clinical practice,and the risk factors affecting the recurrence of breast phyllodes tumor;Second,to analysis the difference of preoperative serum prolactin(PRL)level between breast phyllodes tumor and fibroadenoma,and the clinical application value of prolactin level in the differential diagnosis of phyllodes tumor and fibroadenoma.Materials and Methods1.Collected case data of breast phyllodes tumor patients from December 2008 to September 2022 in the Department of Breast Surgery of Shandong University Qilu Hospital(a total of 274 patients with breast phyllodes tumor in the past 14 years were collected).The accuracy rate of clinical diagnosis,the misdiagnosis rate/low diagnosis rate of the first pathological diagnosis,the current situation of misdiagnosis and low diagnosis,and the recurrence status after the first operation were analyzed.2.Collected clinical data and serum prolactin level of patients with breast phyllodes tumor and fibroadenoma from January 2020 to September 2022 in the Department of Breast Surgery of Shandong University Qilu Hospital.(A total of 41 patients with breast phyllodes tumor were collected.)To analyze the differential diagnosis value of serum prolactin level between phyllodes tumor and fibroadenoma.Results1.Analysis of clinicopathologic features of breast phyllodes tumors1.1 A total of 274 patients with breast phyllodes tumor in the past 14 years were collected.The mean age was 40.34±12.33 years old,with the minimum age being 10 years old and the maximum age being 70 years old.There were 202 patients with benign PT,46 patients with borderline PT,and 26 patients with malignant PT.Compared with borderline PT,the diagnosis age of benign PT was younger,the proportion of patients with menopause and nursing history was lower(P<0.01).1.2 In this group,the pathologic diagnosis accuracy of 274 patients with breast phyllodes tumors after the first operation was 45.99%,and the accuracy of benign,borderline and malignant PT were 42.57%,47.83%and 73.07%,respectively.Among 202 patients with benign phyllodes tumor,114 cases(56.44%)were misdiagnosed,with the highest misdiagnosis rate.Among them,103 cases were misdiagnosed as fibroadenoma,10 cases as fibroepithelial tumor,and 1 cases as intraductal papilloma.Among 46 cases of borderline phyllodes tumor,23 cases were misdiagnosed(50.00%),the second highest rate of misdiagnosis.Among them,19 cases were misdiagnosed as fibroadenoma and 4 cases were misdiagnosed as fibroepithelial tumors.Among the 26 patients with malignant phyllodes tumor,3 cases(11.54%)were misdiagnosed,with the lowest misdiagnosis rate.Of these,2 cases were misdiagnosed as fibroadenoma and 1 cases was misdiagnosed as fibroepithelial tumor.1.3 Among the 274 cases of phyllodes tumor in this group,65 patients recurred after the first operation,among which 41 patients were pathologically misdiagnosed as fibroadenoma after the first operation,with a misdiagnosis rate of 63.08%.Of the 65 patients with recurrent phyllodes tumors,35 cases were benign,18 cases were borderline,and 12 cases were malignant.Of the 35 recurrent benign patients,28 cases(80.00%)were misdiagnosed as fibroadenoma;Of the 18 recurrent borderline patients,11 cases(61.11%)were misdiagnosed as fibroadenoma.Of the 12 recurrent malignant patients,2 cases(16.67%)were misdiagnosed as fibroadenoma.2.Preoperative serum prolactin levels and hyperprolactimia between fibroadenoma and phyllodes tumor.Preoperative serum prolactin data were collected.A total of 41 patients with breast phyllodes tumor were included,including 25 benign patients,11 borderline patients,4 malignant patients,and 127 patients with breast fibroadenoma.Analysis of the relationship between preoperative serum prolactin level and pathological characteristics in patients with breast phyllodes tumor and fibroadenoma showed that there was a statistical difference in preoperative serum prolactin level between patients with breast phyllodes tumor and fibroadenoma(P=0.039),and fibroadenoma patients had a higher level of prolactin.At the same time,more patients in fibroadenoma had preoperatively hyperprolactinemia than those with breast phyllodes tumors(P=0.049).However,there was no significant difference in preoperative serum prolactin level between the four groups of patients with benign,borderline,malignant phyllodes tumor and fibroadenoma(P=0.172),and there was no significant difference between the three groups of patients with benign phyllodes tumor,borderline and malignant phyllodes tumor,and fibroadenoma(P=0.084).Conclusions1.The misdiagnosis rate of the first pathological diagnosis in breast phyllodes tumors is high,especially in benign and borderline phyllodes tumors,which are mainly misdiagnosed as fibroadenoma.2.In patients with recurrent phyllodes tumors,the misdiagnosis rate of the first pathological diagnosis is higher,mainly misdiagnosed as fibroadenoma.3.There was a statistical difference in preoperative serum PRL level between phyllodes tumor and fibroadenoma.Compared with breast phyllodes tumor,fibroadenoma patients had higher preoperative serum prolactin level,and more patients had preoperative hyperprolactimia. |
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