What is the role of imaging studies in the workup of phyllodes tumor (cystosarcoma phyllodes)?

Updated: Jul 20, 2021
  • Author: Donald R Lannin, MD; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Although mammography and ultrasonography (US) generally are important in the diagnosis of breast lesions, they are notoriously unreliable in differentiating benign phyllodes tumors from malignant phyllodes tumors or from fibroadenomas. (The phyllodes tumor’s mammographic appearance, as a round density with smooth borders, is similar to that of fibroadenoma.) Magnetic resonance imaging (MRI) has not been well studied in this setting. [17]  Thus, findings on imaging studies are not definitively diagnostic of phyllodes tumors. [18]

A retrospective study by Kawashima et al suggested that intravoxel incoherent motion (IVIM) MRI could differentiate phyllodes tumors from fibroadenomas by comparing the apparent diffusion coefficient (ADC) values. [19]  The study included seven fibroadenomas and 15 phyllodes tumors (10 benign, four borderline, and one malignant). The authors found that on IVIM MRI, the ADC was higher in borderline and malignant phyllodes tumors than in fibroadenomas, whereas the opposite was true for the perfusion-related diffusion coefficient (D*).

A study by Niu et al suggested that the application of artificial intelligence to quantitative analysis of ultrasound data could improve the ability to distinguish between phyllodes tumor and fibroadenoma. [20]

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