Category Archives: Uncategorized

I was just diagnosed with Phyllodes Tumor of the Breast. What does this mean?

First, let me say that I do not want to interfere with your medical care and your relationship with your treating doctors. Your doctors are more familiar with the details of your case and I would be doing you a disservice to pretend otherwise. I defer to their expertise. Please make sure you follow up with your doctor.

My answer below to your question is intended to be for general informational purposes only and not medical advice.

However, generically speaking, I can provide you with a short overview of Phyllodes tumors and some of the more common considerations encountered by patients and physicians when treating these tumors and I hope that this information is helpful to you.

phyllodes

First, Phyllodes tumors are relatively rare. Because of this, we don’t have too many large studies that enable us to fine-tune our evidence based medicine approach. Stated another way, we just don’t have as much experience with them as we do with other tumors. However, there are still a few things that almost everyone agrees upon that should be helpful to you.

In general, Phyllodes tumors (note alternative spellings and various pronunciations are common) can be relatively difficult to diagnose. They often look just like a fibroadenoma on ultrasound and mammogram and even when a biopsy is done, it can still be hard to determine specific characteristics of the tumor under the microscope. This is in part because Phyllodes tumors exhibit a spectrum of behavior from benign to malignant.

One of the most useful characteristics to determine how the tumor is behaving (benign versus malignant) is to look at how quickly the cells are dividing. The quicker the cells are dividing (generally referred to as mitotic rate), the more aggressive the tumor and the more likely it is malignant. Because cells may divide at different rates in different areas, it is useful to examine a larger area of tissue to get a more accurate overall impression. For this reason it is useful to have as much tissue as possible for examination.

However, mitotic rate is not the whole story, there are other very specific tissue characteristics which require special tests to be done on the tissue which can give clues about the tumor’s behavior. For this reason, it is useful to have an expert pathologist familiar with Phyllodes tumors make the diagnosis. Often, even with the best of circumstances, the Phyllodes tumor can only be classified as “middle grade” or somewhere between benign and malignant.

In any event, because of all of these considerations, it is widely agreed upon that the tumor should always be removed regardless of the initial impression from biopsy (whether benign, borderline/intermediate grade, or malignant). This is done by completely removing the tumor along with some surrounding normal breast tissue to ensure removal is as complete as possible (known as wide local excision). A surgeon with experience in removing tumors from the breast should be able to successfully perform the surgery.

After the tumor is removed, all of the tissue will be examined and a final diagnosis will be made about the tumor. About 10-25% of the tumors are determined to be malignant. However, most of the time the removal of the tumor alone is curative. A small percentage of the time the tumor returns and a second surgery is needed. In general, no other therapy other than surgery is recommended to treat Phyllodes tumors. The overwhelming majority of all patients with a diagnosis of Phyllodes tumors on biopsy do remarkably well.

I hope this helps.

Ryan Polselli, MD, DABR

Advertisements

What is the Relationship Between Fibroadenoma and Breast Cancer?

For all practical purposes, there is no significant relationship between a “true” fibroadenoma and breast cancer.

However, there is slight overlap in the mammographic and sonographic appearance of some fibroadenomas and some uncommon forms of breast cancer. For this reason, care should be taken when attempting to make the diagnosis of a breast fibroadenoma without a biopsy.

Usually this means if biopsy is not performed, at a minimum the potential “fibroadenoma” should be followed over an extended period of time (usually a minimum of two years) to be sure it’s not a slow growing breast cancer masquerading as a “fibroadenoma.”

Also, even if a biopsy is performed, there is some overlap between a fibroadenoma and other tumors. Fibroadenomas belong to a class of tumors in the breast known as fibroepithelial lesions. Rarely (exceedingly rare), the tissue obtained from the tumor during the biopsy can be difficult to differentiate from a “relative” of the fibroadenomas in the same class of tumors known as a Phyllodes tumor (of which a small percent can be malignant).

For this reason, even after a biopsy, at least one follow up visit may still be indicated for a fibroadenoma diagnosed by biopsy, but it’s usually just due to an over abundance of caution because no-one wants to miss a sneaky form of breast cancer.

Ryan Polselli, M.D., Breast Imaging Radiologist

Breast Cancer Screening: Technology or Radiologist

There’s a lot of press about the importance of a 3-D mammogram (breast tomosynthesis) and how much better it is in terms of detecting cancer than the traditional 2-D (standard digital) mammogram.

Here’s a little known secret:

While it is true that there is a difference in the cancer detection rate between the two technologies, what I notice on a daily basis is that the most important consideration for a patient should actually be who interprets their study.

A mammogram is one of the most subjective radiological studies in the field of radiology and there are huge differences in the breast cancer detection rates between radiologists.

I often see breast cancers that were missed (on both 2-D and 3-D mammograms) that would have been detected if a different radiologist had interpreted the study.

Interestingly, most of these statistics are recorded and regularly reported for radiologists. However, they are rarely made public. In part, there is resistance to releasing data such as this because of the potential for misinterpretation by patients and the public in general.

However, today’s patients are increasingly sophisticated and it is my personal opinion that it may be time to bring awareness to this topic.

-Ryan Polselli, M.D.

Fellowship Trained, Breast Imaging Radiologist

Should I Have a Mammogram Yearly or Every Other Year

I have written about this before, but I receive so many questions about this on a daily basis that I want to revisit the question.

There are organizations that advocate both.

Organizations such as the United States Preventative Services Task Force (USPSTF) advise mammograms every other year. They acknowledge that many cancers will be missed with this model, but they believe the number is “small” (it is estimated an additional 100,000 women will die as a result of the recommendations) but they believe this is outweighed by the anxiety, additional biopsies, and the potential for misdiagnosis that can occur by yearly mammograms.

Organizations such as the American College of Radiology (ACR), still recommend yearly mammograms because they believe the number of lives that will be saved by yearly screening far outweighs the anxiety, the extra biopsies, and the potential for misdiagnosis.

I personally want every important woman in my life to have a mammogram every year because I am more concerned that they could end up as one of the 100,000 women that will die from a missed cancer than I am that they could experience some anxiety, an extra biopsy, or misdiagnosis.

But this may not be the right decision for everyone and most importantly I believe in patients being given all the facts…and the freedom…to make their own choices.

-Ryan Polselli, M.D.

Fellowship Trained Breast Imaging Radiologist

Augmentation Desperation

mammogram-of-free-silicone-in-the-breast
Mammogram of Free Silicone Injected into the Breast
Picture-of-Ryan-Polselli
Ryan Polselli

This image demonstrates the consequences of injecting free silicone into the breast.

Patients looking for a quick and cheap fix to enlarge their breasts sometimes resort to injecting silicone (frequently automotive grade silicone from a tube).

For patients that are lucky enough to avoid some of the initial risks such as infection, the initial breast enlargement is short-lived. As the breast tissue reacts to the free silicone, it always forms an extremely lumpy, marble-like appearance that is essentially permanent. Patients that wish to correct the appearance must undergo extensive surgical reconstruction that still leaves the breasts disfigured.

Although this practice has been around for several years, it is surprising that it continues.

Ryan Polselli, M.D.

Breast Pain

Ryan Polselli
Ryan Polselli

Breast pain is one of the most common complaints heard by a breast imager.  It inevitably generates a lot of questions. Because it is so common, over time I have developed somewhat of a standard speech for patients that answers the most common questions and concerns. This is what I usually say:

The good news is…breast pain is almost never associated with breast cancer. Cancer almost always presents as a painless lump in the breast. Having said that, we don’t like to take any chances and we fully investigate the cause of the breast pain. Once we have completely evaluated the cause of the pain, and if we find nothing concerning with the history, the physical examination, and the imaging findings (mammogram and ultrasound), we are as certain as we can be that there is nothing to worry about from a cancer screening standpoint.

The bad news is…breast pain is not easily treated. There is one proven, tried and true therapy that will relieve some of the pain…anti-inflammatory pain relievers such as ibuprofen or naproxen (Advil or Aleve).  However, there are many patients that cannot and or should not take these medications so check with your referring physician first. There are a couple of other therapies that vary in their effectiveness depending on the patient. Some patients swear that eliminating or cutting back on caffeine intake significantly reduces or eliminates the pain while others say it has no effect. Some patients  also report benefit from vitamin E supplementation while others do not. Of all of the therapies that I have heard patients try, these are the only ones that are consistently mentioned to me to provide relief.

There are always specific questions and I do my best to answer them. After all questions have been answered I always like to express one final thought…I am always happy to have a patient investigate any breast concern no matter how “small” or “trivial” that a patient may think it is…because you never know…and in this field it can never hurt to exercise a little caution.

Ryan Polselli, M.D.