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 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

University of Nottingham
Hamad Medical Corporation
University College Dublin
Flinders Medical Centre
Stanford University
Emory University
Memorial Sloan-Kettering Cancer Center
University of Galway
Centre de Recherche en Cancérologie de Marseille
Veterans General Hospital-Taichung Taiwan
Chung Shan Medical University
University of California at San Francisco
Harvard University
Bács-Kiskun County Teaching Hospital
University of Szeged
Institut Curie
Lenox Hill Hospital
University of Bologna
Universidade Federal do Triângulo Mineiro
KK Women's and Children's Hospital
Kameda General Hospital
Semmelweis University
Eurofins Medserv Ltd
Tokyo Women's Medical University
University of Queensland
Kawasaki Medical School
The University of Sydney
Royal Prince Alfred Hospital
King's College London
Guy's and St Thomas' NHS Foundation Trust
Cambridge University Hospitals NHS Foundation Trust
University of Texas MD Anderson Cancer Center
University of Porto
University of Birmingham
Northwestern University
Loyola University Medical Center
Chinese University of Hong Kong
University of Zurich
Nagasaki University
Fudan University
University of Melbourne
Brigham and Women’s Hospital
Dana-Farber Cancer Institute
Nottingham University and Honorary Consultant Pathologist Nottingham City Hospital
Singapore

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

9 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
Journal	Modern Pathology
Volume	38
Issue number	5
DOIs	https://doi.org/10.1016/j.modpat.2025.100734
Publication status	Published - May 2025
Externally published	Yes

Bibliographical note

Publisher Copyright:
© 2025 The Authors

UN SDGs

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

SDG 3 Good Health and Well-being

Keywords

breast cancer
core needle biopsy
fibroepithelial lesions
reporting

Access to Document

10.1016/j.modpat.2025.100734

Cite this

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{b837ed55d34e483ca10502e2cdf4b0a9,

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 Chen, \{Yunn Yi\} 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\}",

note = "Publisher Copyright: {\textcopyright} 2025 The Authors",

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, YY, 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 - https://www.scopus.com/pages/publications/86000360854

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

Bibliographical note

UN SDGs

Keywords

Access to Document

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