Breast Cancer Research and Treatment

, Volume 178, Issue 1, pp 51–56 | Cite as

Accuracy and clinical implications of pre-operative breast core needle biopsy diagnoses of fibroepithelial neoplasms and sarcomatoid carcinomas

  • Alisha D. Ware
  • Pedram Argani
  • Ashley Cimino-MathewsEmail author
Preclinical study



Accurate classification of breast phyllodes tumors (PTs) on core biopsy can be challenging. The differential diagnosis of benign PT (BP) is fibroadenoma (FA), whereas the differential diagnosis of malignant PT (MP) is sarcomatoid (metaplastic) carcinoma (SC).


Here, we compare the pre-excision core biopsy diagnosis and clinicopathologic features of histologically confirmed MP, borderline PT (BLP), BP, FA, and SC. Consecutive cases of 34 histologically confirmed PT (14 MP, 10 BLP, 10 BP), 13 SC, and 10 FA were identified.


A core biopsy diagnosis of SC was made only in SC (77%, p = 0.003). The diagnosis “malignant neoplasm” or “atypical spindle cell neoplasm” was made in 100% MP and 23% SC, but no other tumor (p = 0.0001). The diagnosis “phyllodes tumor” was made only in PT (44% BLP, 11% BP, p = 0.06). The diagnosis “fibroepithelial lesion” was made in 44% BLP, 67% BP, and 29% FA. The diagnosis “FA” was made most commonly in FA (57%) (versus 22% BP and no other tumor; p = 0.002). Neoadjuvant therapy was given only in SC (23%, p = 0.03); adjuvant therapy was given in 46% SC and 13% MP (p = 0.04).


A pre-operative core biopsy diagnosis of “malignant spindle cell neoplasm” separates MP and SC from BLP, BP, and FA. However, MP and SC can have overlapping features on core biopsy. Thus, one must be careful not to overcall SC on core biopsy, as patients diagnosed with SC may receive neoadjuvant therapy. A core biopsy diagnosis of “phyllodes tumor” is specific for PT and can guide treatment planning of a wide local excision.


Phyllodes tumor Malignant phyllodes tumor Sarcomatoid carcinoma Fibroepithelial lesion Core biopsy 


Compliance with ethical standards

Conflict of interest

Dr. Cimino-Mathews receives research grants from Bristol-Myers Squibb and the HeritX foundation, unrelated to the work presented in this current study. Drs. Ware and Argani declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors. The study is approved by the Johns Hopkins Institutional Review Board to utilize de-identified, archival pathology specimens.


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.The Department of PathologyThe Johns Hopkins HospitalBaltimoreUSA
  2. 2.The Departments of Pathology and OncologyThe Johns Hopkins HospitalBaltimoreUSA

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