Interobserver variability by pathologists in the distinction between cellular fibroadenomas and phyllodes tumors

Thomas J. Lawton, Geza Acs, Pedram Argani, Gelareh Farshid, Michael Gilcrease, Neal Goldstein, Frederick Koerner, J. Jordi Rowe, Melinda Sanders, Sejal S. Shah, Carol Reynolds

Research output: Contribution to journalArticle

41 Scopus citations

Abstract

Fibroepithelial lesions with cellular stroma are frequently termed cellular fibroadenomas although criteria for distinguishing them from a phyllodes tumor are vague and subjective. However, the clinical implications and surgical management for these 2 lesions may be different. We randomly selected 21 cases of fibroepithelial lesions sent in consultation to the senior author that were challenging to classify as cellular fibroadenoma or phyllodes tumor. One to 2 representative slides of each case along with patient age were sent to 10 pathologists who specialize in breast pathology. The World Health Organization criteria for phyllodes tumors and a diagnosis form were included with the study set. For the purposes of data reporting, fibroadenoma and cellular fibroadenoma are considered together. In only 2 cases was there uniform agreement as to whether the tumor represented a fibroadenoma or phyllodes tumor. Of the remaining 19 cases, if the diagnoses of fibroadenoma and benign phyllodes tumor were combined and separated from borderline and malignant phyllodes tumors, there was 100% agreement in 53% of cases and 90% agreement in 79% of cases. This study highlights the difficulty that exists in distinguishing some cellular fibroadenomas from phyllodes tumors even for pathologists who specialize in breast pathology. However, there appears to be considerable agreement when cellular fibroadenomas and benign phyllodes tumors are distinguished from borderline and malignant phyllodes tumors. Further studies are needed to determine if there is a clinically significant difference between cellular fibroadenomas and benign phyllodes tumors and how to better distinguish them from borderline and malignant phyllodes tumors.

Original languageEnglish (US)
Pages (from-to)695-698
Number of pages4
JournalInternational Journal of Surgical Pathology
Volume22
Issue number8
DOIs
StatePublished - Dec 10 2014

Keywords

  • cellular fibroadenoma
  • fibroepithelial lesion
  • phyllodes tumor

ASJC Scopus subject areas

  • Anatomy
  • Surgery
  • Pathology and Forensic Medicine

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    Lawton, T. J., Acs, G., Argani, P., Farshid, G., Gilcrease, M., Goldstein, N., Koerner, F., Rowe, J. J., Sanders, M., Shah, S. S., & Reynolds, C. (2014). Interobserver variability by pathologists in the distinction between cellular fibroadenomas and phyllodes tumors. International Journal of Surgical Pathology, 22(8), 695-698. https://doi.org/10.1177/1066896914548763