A Pre-operative Score to Discriminate Fibroepithelial Lesions of the Breast: Phyllode Tumor or Fibroadenoma?

BACKGROUND/AIM: Fibroepithelial lesions (FEL) of the breast include fibroadenomas and phyllodes tumors (PT). Their histologic characteristics on core needle biopsy can overlap, while their clinical management is different. The aim of this study was to develop and to validate a pre-operative score for the diagnosis of PT with surgical decision rules. PATIENTS AND METHODS: We developed a pre-operative score for the diagnosis of PT by performing logistic regression on 217 FEL of the Rene Huguenin Hospital. This score and the surgical decision rules were validated on 87 FEL of the Lariboisiere Hospital. RESULTS: Three variables were independently and significantly associated with PT: age ≥40 years, mammography's tumor size ≥3 cm and PT diagnosed by CNB. The pre-operative score was based on these three criteria with values ranging from 0 to 10. Surgical decision rules were created: the low-risk group of PT (score≤2) had a sensitivity of 92.6% and a LR- of 0.2, the high-risk group (score>7) had a specificity of 93.5% and a LR+ of 4.4. In the validation sample, surgical decision rules were applied. CONCLUSION: These surgical decision rules may prove useful in deciding which FEL needs surgical resection.

Experimental study of pedicled subcostal artery perforator (SCAP) flap: A new application in breast reconstruction.

BACKGROUND: Latissimus dorsi flap is the gold standard for pedicled breast reconstruction but is limited by donor site scarring, which is difficult to conceal, and a high rate of post-operative seroma. We investigated the anatomic characteristics and feasibility of using a subcostal artery perforator (SCAP) flap, which was taken from the flank area and vascularised by a perforator artery through a subcostal pedicle, for a breast reconstruction. METHODS: A literature review was undertaken to determine the anatomy of the SCAP flap pedicle and the vascular supply to this dermal-fat flap. Pedicled SCAP flaps were dissected on cadavers to identify the anatomy of the perforator arteries and the pedicle length. Pedicled SCAP flaps were then tunnelled through the chest area to evaluate their feasibility for breast reconstruction. RESULTS: Twelve SCAP flaps were prepared on six cadavers. Mean pedicle length was 17 cm (14.5-20 cm). Mean flap size was 13 × 18 cm (11.5 × 15.5-15 × 21 cm). For each flap, a pedicle of sufficient length was dissected to allow the tunnelling of the flap and to perform breast reconstruction with a dermal-fat flap of adequate size. In all cases, an SCAP flap was prepared, without taking muscle, to reduce the risk of parietal complications at the donor site in future clinical applications. CONCLUSION: Pedicled SCAP flap is a feasible option in breast reconstruction and could represent a less arduous surgical alternative to free flaps for some patients. Donor site scarring was acceptable. Clinical application of SCAP flaps should be investigated further.