Problems of diagnostics and treatment of the epithelial and non-epithelial breast tumors

Study objective. To improve diagnostics quality and surgical treatment efficiency in patients with non-epithelial and fibroepithelial malignant breast tumors.Materials and methods. The non-randomized study included 87 patients, among them 16 patients with breast sarcomas and 71 patients with phyllodes tumors of the breast. Primary diagnosis was made based on mammography, ultrasound scan (including contrast-enhanced ultrasound), and sonoelastography data. Organ-preserving surgeries were performed in 48 (67.6 %) patients with phyllodes tumors and 2 (13 %) patients with sarcomas, mastectomy and breast amputations were performed in 23 (32.4 %) patients with phyllodes tumors and 14 (87 %) patients with sarcomas. Follow-up duration varied between 3 and 132 months.Results and discussion. During routine examination of patients with phyllodes tumors and sarcomas diagnostic errors were made in 62 and 20 % of cases, respectively. Sonoelastography and contrast-enhanced ultrasound allowed to make a correct diagnosis in the majority of patients (70 %). Long-term treatment results correlated with tumor type. Over all survival for benign phyllodes tumors was significantly higher (97.6 %) than overall survival for its malignant type (57 %) and breast sarcomas (60 %). Sparing tumor removal (tumorectomy) was associated with high incidence of local recurrences for all types of non-epithelial and fibroepithelial tumors (between 31 % and 100 %). Segmental resection was also associated with high incidence of local recurrences, especially for the malignant type of phyllodes tumor (83 %).Conclusion. Primary diagnostics of breast diseases should involve sonoelastography and a contrast-enhanced ultrasound scan. Surgical treatment for malignant phyllodes tumors and sarcomas should include breast amputation or mastectomy.