FROM TRUCUT TO EXCISION: HISTOPATHOLOGICAL PROFILE OF FIBROEPITHELIAL BREAST TUMORS IN SOUTH PUNJAB, PAKISTAN
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Keywords
Fibroepithelial breast tumor, fibroadenoma, phyllodes tumor, trucut biopsy, excision biopsy
Abstract
Background: Fibroepithelial breast tumors represent a diagnostic challenge, particularly in distinguishing fibroadenomas from phyllodes tumors on trucut biopsy. Misclassification often leads to under- or overtreatment. Excision biopsy remains the gold standard for definitive diagnosis.
Objective: This study aimed to analyze the histopathological features of breast lesions initially diagnosed as fibroepithelial tumors on trucut biopsy and to compare them with findings on excision biopsy at a tertiary care hospital in South Punjab, Pakistan.
Material & Methods: This descriptive cross-sectional study was conducted in the Department of Pathology, Quaid-e-Azam Medical College/ Bahawal Victoria Hospital, Bahawalpur, from October 2022 to December 2023, after approval from the Institutional Ethical Review Committee (IERB) through notification No. 1329/DME/QAMC Bahawalpur dated 25/09/22. A total of 150 patients with fibroepithelial lesions diagnosed on trucut biopsy who subsequently underwent excision biopsy were included. Clinical data, imaging findings, and histological parameters such as stromal cellularity, nuclear atypia, mitotic activity, stromal overgrowth, and stromal-epithelial ratio were assessed. Statistical analysis was performed using SPSS v23, and a p-value of <0.05 was considered significant.
Results: The mean age of patients was 34.2 ± 10.1 years, with a mean tumor size of 42.6 ± 26.5 mm. At excision, 106 cases (70.7%) were confirmed as fibroadenomas, while 44 cases (29.3%) were phyllodes tumors (benign, borderline, or malignant). Tumors >30 mm were significantly associated with phyllodes diagnosis (p < 0.001). Increased stromal cellularity, marked atypia, and mitotic counts >5/10 HPF were strongly predictive of phyllodes tumors on excision.
Conclusion: Trucut biopsy has limitations in differentiating fibroadenomas from phyllodes tumors due to overlapping histological features. Tumor size, stromal cellularity, mitotic activity, and stromal overgrowth should be considered as indicators for surgical excision. Excision biopsy remains essential for accurate diagnosis and management of fibroepithelial breast tumors in this region.
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