Differentiation between phyllodes tumor and fibroadenoma using real-time elastography

B R Adamietz, L Kahmann, P A Fasching, R Schulz-Wendtland, M Uder, M W Beckmann, M Meier-Meitinger
Ultraschall in der Medizin 2011, 32 Suppl 2: E75-9

PURPOSE: Phyllodes tumors (PT) are a rare entity accounting for less than 1 % of all breast lesions. They have a malignancy rate of 25-30%. Differentiation from benign fibroadenomas is difficult using ultrasound, mammogram and MRI. The elastic characteristics of both tumors were examined using real-time elastography (RTE) to find specific patterns that make differentiation possible.

MATERIALS AND METHODS: From February 2007 to May 2009, a total of 620 women were examined by RTE. Histological diagnosis was achieved using core needle biopsy. 123 of the lesions were fibroadenomas, 8 were phyllodes tumors. All patients underwent mammography and ultrasound followed by RTE. Sonography was performed by Acuson Antares, Premium Edition® (Siemens, Erlangen, Germany) with a 7 and 10 MHz transducer.

RESULTS: All phyllodes tumors had a similar elastic pattern with an elastic center and inelastic outer limits, referred to as the "ring sign". It was found in 5% of all fibroadenomas.

CONCLUSION: RTE provides a specific elastic pattern, which is sufficient for differentiating between a fibroadenoma and a phyllodes tumor. Therefore, the detection of the most suspicious lesion in women with the coexistence of multiple fibroadenomas and phyllodes tumors seems easier.

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