title: Perioperative diagnosis of cystosarcoma phyllodes of the breast may be enhanced by MIB-1 index.
abstract: BACKGROUND
  The recurring theme in cystosarcoma phyllodes (CSP) is one of underdiagnosis by pathologists and undertreatment by surgeons. Major areas of investigation relating to the diagnosis of CSP center on accurate preoperative diagnosis, elucidating the relevance of histological classification with respect to outcome, and identifying novel markers to reliably differentiate CSP from fibroadenoma (FA).
  
  
  METHODS
  Fifteen CSP and 7 cellular FA controls (where the preoperative diagnosis was unclear) were retrospectively investigated. Preoperative histological and radiological investigations were reviewed for efficacy. The ability of MIB-1 antibody to differentiate the two fibroepithelial lesions was investigated using immunohistochemical estimation of the MIB-1 index.
  
  
  CONCLUSIONS
  Preoperative core biopsy had a sensitivity of 75% but was carried out in only 23% of cases. Fine needle aspiration cytology and radiological assessment were not efficacious in preoperative diagnosis. Proliferative activity (MIB-1 indices) was significantly higher in CSP than in a selected population of FA where there was preoperative diagnostic uncertainty (P < 0.0001). Indices were also able to determine CSP subclassification. This suggests MIB-1 as a constructive adjunctive investigation when evaluating histological features to differentiate CSP from FA in difficult cases.
  
  
  CONCLUSIONS
  The use of MIB-1 may increase the sensitivity of preoperative core biopsy diagnosis, offering more effective surgical planning and decreasing immediate reoperation rates.
authors.affiliation: Department of Surgical Oncology and Technology, Imperial College Faculty of Medicine, St. Mary's Hospital, London, United Kingdom. p.ridgway@ic.ac.uk
authors.forename: P F
authors.initials: PF
authors.lastname: Ridgway
authors.forename: R K
authors.initials: RK
authors.lastname: Jacklin
authors.forename: P
authors.initials: P
authors.lastname: Ziprin
authors.forename: L
authors.initials: L
authors.lastname: Harbin
authors.forename: D H
authors.initials: DH
authors.lastname: Peck
authors.forename: A W
authors.initials: AW
authors.lastname: Darzi
authors.forename: P B
authors.initials: PB
authors.lastname: Rajan
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D001943:Breast Neoplasms / Q000737:chemistry / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D018226:Fibroadenoma / Q000175:diagnosis; D006801:Humans; D007150:Immunohistochemistry; D019394:Ki-67 Antigen / Q000032:analysis*; D008875:Middle Aged; D003557:Phyllodes Tumor / Q000737:chemistry / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D019394:Ki-67 Antigen