Classification of Fibroepithelial Lesions of the Breast in Core Needle Biopsy With Implications for Further Management

Emad A. Rakha; Cecily Quinn; Wendy Raymond; Kimberly H. Allison; Sunil S. Badve; Edi Brogi; Grace Callagy; Emmanuelle Charafe-Jauffret; Chih Jung Chen; Yunn-Yi Chen; Laura C. Collins; Gábor Cserni; Lounes Djerroudi; Shabnam Jaffer; Maria Pia Foschini; Helenice Gobbi; Mihir Gudi; Oi Harada; Janina Kulka; Hajime Kuroda; Sunil R. Lakhani; Xiaoxian Li; Takuya Moriya; Sandra A. O'Toole; Sarah E. Pinder; Elena Provenzano; Aysegul A. Sahin; Fernando Schmitt; Abeer M. Shaaban; Kalliopi P. Siziopikou; Ping Tang; Gary M. Tse; Zsuzsanna Varga; Anne Vincent-Salomon; Hannah Wen; Rin Yamaguchi; Wentao Yang; Stephen B. Fox; Stuart J. Schnitt; Ian O. Ellis; Puay Hoon Tan

doi:10.1016/j.modpat.2025.100734

Classification of Fibroepithelial Lesions of the Breast in Core Needle Biopsy With Implications for Further Management

Emad A. Rakha, Cecily Quinn, Wendy Raymond, Kimberly H. Allison, Sunil S. Badve, Edi Brogi, Grace Callagy, Emmanuelle Charafe-Jauffret, Chih Jung Chen, Yunn-Yi Chen, Laura C. Collins, Gábor Cserni, Lounes Djerroudi, Shabnam Jaffer, Maria Pia Foschini, Helenice Gobbi, Mihir Gudi, Oi Harada, Janina Kulka, Hajime KurodaSunil R. Lakhani, Xiaoxian Li, Takuya Moriya, Sandra A. O'Toole, Sarah E. Pinder, Elena Provenzano, Aysegul A. Sahin, Fernando Schmitt, Abeer M. Shaaban, Kalliopi P. Siziopikou, Ping Tang, Gary M. Tse, Zsuzsanna Varga, Anne Vincent-Salomon, Hannah Wen, Rin Yamaguchi, Wentao Yang, Stephen B. Fox, Stuart J. Schnitt, Ian O. Ellis, Puay Hoon Tan

College of Medicine and Public Health

Research output: Contribution to journal › Review article › peer-review

5 Citations (Scopus)

Abstract

Fibroepithelial lesions (FELs) of the breast represent a diverse group of biphasic tumors with varying morphologies and clinical behavior. The classification of FELs is mainly based on a constellation of diagnostic criteria, and intralesional heterogeneity is not uncommon. Therefore, reporting FELs in a core needle biopsy (CNB) with limited tissue material can be challenging as not all the features may be represented for assessment. Differentiating a classic fibroadenoma from a well-sampled phyllodes tumor (PT) is generally straightforward. However, cellular fibroadenoma, morphologically heterogeneous benign PT, and myoid hamartoma can overlap histologically. Accurate grading of PT is also challenging on CNB and carries significant management implications. In this article, we provide an overview and propose a pragmatic approach to reporting FELs on CNB, particularly for lesions with overlapping features. Guidance using the UK/European “B” classification of FELs alongside descriptive reporting of the various lesions, is also presented to aid in management decisions.

Original language	English
Article number	100734
Number of pages	21
Journal	Modern Pathology
Volume	38
Issue number	5
DOIs	https://doi.org/10.1016/j.modpat.2025.100734
Publication status	Published - May 2025

Keywords

breast cancer
core needle biopsy
fibroepithelial lesions
reporting

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.modpat.2025.100734Licence: CC BY

Published versionFinal published version, 25 MBLicence: CC BY

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Rakha, E. A., Quinn, C., Raymond, W., Allison, K. H., Badve, S. S., Brogi, E., Callagy, G., Charafe-Jauffret, E., Chen, C. J., Chen, Y.-Y., Collins, L. C., Cserni, G., Djerroudi, L., Jaffer, S., Foschini, M. P., Gobbi, H., Gudi, M., Harada, O., Kulka, J., ... Tan, P. H. (2025). Classification of Fibroepithelial Lesions of the Breast in Core Needle Biopsy With Implications for Further Management. Modern Pathology, 38(5), Article 100734. https://doi.org/10.1016/j.modpat.2025.100734

@article{8f3f023910ee4c45bddbff70a15a40c8,

title = "Classification of Fibroepithelial Lesions of the Breast in Core Needle Biopsy With Implications for Further Management",

abstract = "Fibroepithelial lesions (FELs) of the breast represent a diverse group of biphasic tumors with varying morphologies and clinical behavior. The classification of FELs is mainly based on a constellation of diagnostic criteria, and intralesional heterogeneity is not uncommon. Therefore, reporting FELs in a core needle biopsy (CNB) with limited tissue material can be challenging as not all the features may be represented for assessment. Differentiating a classic fibroadenoma from a well-sampled phyllodes tumor (PT) is generally straightforward. However, cellular fibroadenoma, morphologically heterogeneous benign PT, and myoid hamartoma can overlap histologically. Accurate grading of PT is also challenging on CNB and carries significant management implications. In this article, we provide an overview and propose a pragmatic approach to reporting FELs on CNB, particularly for lesions with overlapping features. Guidance using the UK/European “B” classification of FELs alongside descriptive reporting of the various lesions, is also presented to aid in management decisions.",

keywords = "breast cancer, core needle biopsy, fibroepithelial lesions, reporting",

author = "Rakha, {Emad A.} and Cecily Quinn and Wendy Raymond and Allison, {Kimberly H.} and Badve, {Sunil S.} and Edi Brogi and Grace Callagy and Emmanuelle Charafe-Jauffret and Chen, {Chih Jung} and Yunn-Yi Chen and Collins, {Laura C.} and G{\'a}bor Cserni and Lounes Djerroudi and Shabnam Jaffer and Foschini, {Maria Pia} and Helenice Gobbi and Mihir Gudi and Oi Harada and Janina Kulka and Hajime Kuroda and Lakhani, {Sunil R.} and Xiaoxian Li and Takuya Moriya and O'Toole, {Sandra A.} and Pinder, {Sarah E.} and Elena Provenzano and Sahin, {Aysegul A.} and Fernando Schmitt and Shaaban, {Abeer M.} and Siziopikou, {Kalliopi P.} and Ping Tang and Tse, {Gary M.} and Zsuzsanna Varga and Anne Vincent-Salomon and Hannah Wen and Rin Yamaguchi and Wentao Yang and Fox, {Stephen B.} and Schnitt, {Stuart J.} and Ellis, {Ian O.} and Tan, {Puay Hoon}",

year = "2025",

month = may,

doi = "10.1016/j.modpat.2025.100734",

language = "English",

volume = "38",

journal = "Modern Pathology",

issn = "0893-3952",

publisher = "Elsevier B.V.",

number = "5",

}

Rakha, EA, Quinn, C, Raymond, W, Allison, KH, Badve, SS, Brogi, E, Callagy, G, Charafe-Jauffret, E, Chen, CJ, Chen, Y-Y, Collins, LC, Cserni, G, Djerroudi, L, Jaffer, S, Foschini, MP, Gobbi, H, Gudi, M, Harada, O, Kulka, J, Kuroda, H, Lakhani, SR, Li, X, Moriya, T, O'Toole, SA, Pinder, SE, Provenzano, E, Sahin, AA, Schmitt, F, Shaaban, AM, Siziopikou, KP, Tang, P, Tse, GM, Varga, Z, Vincent-Salomon, A, Wen, H, Yamaguchi, R, Yang, W, Fox, SB, Schnitt, SJ, Ellis, IO & Tan, PH 2025, 'Classification of Fibroepithelial Lesions of the Breast in Core Needle Biopsy With Implications for Further Management', Modern Pathology, vol. 38, no. 5, 100734. https://doi.org/10.1016/j.modpat.2025.100734

TY - JOUR

T1 - Classification of Fibroepithelial Lesions of the Breast in Core Needle Biopsy With Implications for Further Management

AU - Rakha, Emad A.

AU - Quinn, Cecily

AU - Raymond, Wendy

AU - Allison, Kimberly H.

AU - Badve, Sunil S.

AU - Brogi, Edi

AU - Callagy, Grace

AU - Charafe-Jauffret, Emmanuelle

AU - Chen, Chih Jung

AU - Chen, Yunn-Yi

AU - Collins, Laura C.

AU - Cserni, Gábor

AU - Djerroudi, Lounes

AU - Jaffer, Shabnam

AU - Foschini, Maria Pia

AU - Gobbi, Helenice

AU - Gudi, Mihir

AU - Harada, Oi

AU - Kulka, Janina

AU - Kuroda, Hajime

AU - Lakhani, Sunil R.

AU - Li, Xiaoxian

AU - Moriya, Takuya

AU - O'Toole, Sandra A.

AU - Pinder, Sarah E.

AU - Provenzano, Elena

AU - Sahin, Aysegul A.

AU - Schmitt, Fernando

AU - Shaaban, Abeer M.

AU - Siziopikou, Kalliopi P.

AU - Tang, Ping

AU - Tse, Gary M.

AU - Varga, Zsuzsanna

AU - Vincent-Salomon, Anne

AU - Wen, Hannah

AU - Yamaguchi, Rin

AU - Yang, Wentao

AU - Fox, Stephen B.

AU - Schnitt, Stuart J.

AU - Ellis, Ian O.

AU - Tan, Puay Hoon

PY - 2025/5

Y1 - 2025/5

N2 - Fibroepithelial lesions (FELs) of the breast represent a diverse group of biphasic tumors with varying morphologies and clinical behavior. The classification of FELs is mainly based on a constellation of diagnostic criteria, and intralesional heterogeneity is not uncommon. Therefore, reporting FELs in a core needle biopsy (CNB) with limited tissue material can be challenging as not all the features may be represented for assessment. Differentiating a classic fibroadenoma from a well-sampled phyllodes tumor (PT) is generally straightforward. However, cellular fibroadenoma, morphologically heterogeneous benign PT, and myoid hamartoma can overlap histologically. Accurate grading of PT is also challenging on CNB and carries significant management implications. In this article, we provide an overview and propose a pragmatic approach to reporting FELs on CNB, particularly for lesions with overlapping features. Guidance using the UK/European “B” classification of FELs alongside descriptive reporting of the various lesions, is also presented to aid in management decisions.

AB - Fibroepithelial lesions (FELs) of the breast represent a diverse group of biphasic tumors with varying morphologies and clinical behavior. The classification of FELs is mainly based on a constellation of diagnostic criteria, and intralesional heterogeneity is not uncommon. Therefore, reporting FELs in a core needle biopsy (CNB) with limited tissue material can be challenging as not all the features may be represented for assessment. Differentiating a classic fibroadenoma from a well-sampled phyllodes tumor (PT) is generally straightforward. However, cellular fibroadenoma, morphologically heterogeneous benign PT, and myoid hamartoma can overlap histologically. Accurate grading of PT is also challenging on CNB and carries significant management implications. In this article, we provide an overview and propose a pragmatic approach to reporting FELs on CNB, particularly for lesions with overlapping features. Guidance using the UK/European “B” classification of FELs alongside descriptive reporting of the various lesions, is also presented to aid in management decisions.

KW - breast cancer

KW - core needle biopsy

KW - fibroepithelial lesions

KW - reporting

UR - http://www.scopus.com/inward/record.url?scp=86000360854&partnerID=8YFLogxK

U2 - 10.1016/j.modpat.2025.100734

DO - 10.1016/j.modpat.2025.100734

M3 - Review article

C2 - 39947480

AN - SCOPUS:86000360854

SN - 0893-3952

VL - 38

JO - Modern Pathology

JF - Modern Pathology

IS - 5

M1 - 100734

ER -

Classification of Fibroepithelial Lesions of the Breast in Core Needle Biopsy With Implications for Further Management

Abstract

Keywords

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