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Differentiation of Phyllodes Breast Tumors from Fibroadenomas on MRI

¹ Department of Mammography, Institute of Diagnostic and Interventional Radiology, Friedrich Schiller University, Bachstrasse 18, Jena D-07740, Germany.
² Institute of Pathology, Friedrich Schiller University, Ziegelmühlenweg, Jena, Germany.
³ Department of Gynaecology, Friedrich Schiller University, Jena, Germany.
⁴ Present address: Department of Gynaecology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.

OBJECTIVE. The purpose of our study was to evaluate the MRI appearance of phyllodes breast tumors and to differentiate them from fibroadenomas.

MATERIALS AND METHODS. MR images were obtained on a 1.5-T imager. T1- and T2-weighted sequences and dynamic 2D fast-field echo T1-weighted sequences were performed. MR images of 23 patients with 24 phyllodes breast tumors (one malignant, 23 benign) were analyzed with respect to morphology and contrast enhancement. The tumors were compared with the MRI appearance of 81 fibroadenomas of 75 patients.

RESULTS. Well-defined margins were seen in 87.5% of the phyllodes tumors and 70.4% of the fibroadenomas, and a round or lobulated shape in 100% and 90.1%, repectively. A heterogeneous internal structure was observed in 70.8% of phyllodes tumors and in 49.4% of fibroadenomas. Nonenhancing internal septations were found in 45.8% of phyllodes tumors and 27.2% of fibroadenomas. A significantly greater increase in signal was seen on T2-weighted images in the tissue surrounding phyllodes tumors (21%) compared with fibroadenomas (1.2%). Most of both lesions appeared with low signal intensity on T1- and T2-weighted images. After the administration of contrast material, 33.3% of phyllodes tumors and 22.2% of fibroadenomas showed a suspicious signal intensity-time course.

CONCLUSION. Phyllodes breast tumors and other fibroadenomas cannot be precisely differentiated on breast MRI. Phyllodes tumors have benign morphologic features and contrast enhancement characteristics suggestive of malignancy in 33% of cases.

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