The risk of probable TD is more than three times lower in older adults receiving SGAs in comparison with FGAs after 1 year of treatment (23% vs 7%). The risk of persistent TD at 1 year with SGAs is particularly low. Evidence is lacking in regard to the longer-term risk of TD with SGAs, although the rates associated with the prolonged use of FGAs are high. Caution is therefore still required, particularly with the protracted use of both FGAs and SGAs.
INTRODUCTION: Phyllodes tumours represent 0.3–1% of breast tumours, typically presenting in women aged 35–55 years. They are classified into benign, borderline and malignant grades and exhibit a spectrum of features. There is significant debate surrounding the optimal management of phyllodes tumour, particularly regarding appropriate margins. METHODS: This is a retrospective review of a prospectively maintained database of patients who underwent surgical management for phyllodes tumours in a single tertiary referral centre from 2007–2017. Patient demographics, tumour characteristics, surgical treatment and follow-up data were analysed. Tumour margins were classified as positive (0 mm), close (≤2 mm) and clear (>2 mm). RESULTS: A total of 57 patients underwent surgical excision of a phyllodes tumour. The Mean age was 37.7 years (range: ages 14–91) with mean follow-up of 38.5 months (range: 0.5–133 months). There were 44 (77%) benign, 4 (7%) borderline and 9 (16%) malignant phyllodes cases. 54 patients had breast conserving surgery (BCS) and 3 underwent mastectomy. 30 (53%) patients underwent re-excision of margins. The final margin status was clear in 32 (56%), close in 13 (23%) and positive in 12 (21%). During follow-up, 4 patients were diagnosed with local recurrence (2 malignant, 1 borderline and 1 benign pathology on recurrence samples). CONCLUSION: There are no clear guidelines for the surgical management and follow-up of phyllodes tumours. This study suggests that patients with malignant phyllodes and positive margins are more likely to develop local recurrence. There is a need for large prospective studies to guide the development of future guidelines.
P opulation-based screening for breast cancer has been shown in a number of studies to reduce breast cancer mortality (1-5). There is a balance to be struck between breast cancer detection rates and recall rates for further assessment. Double reading of screening mammograms can improve cancer detection by 6%-15% when compared with single-reader reporting (6-8). However, interobserver variability exists in mammographic interpretation (9). To reduce unnecessary recalls for further imaging, a process of consensus or arbitration by independent readers can be used when there are discordant results between individual screening readers.We previously published data on consensus outcomes for screen-film mammography, in which 128 569 screening mammograms obtained during a 6-year period were reviewed (10). A total of 1335 women (1%) were discussed at consensus review; 606 of the 1335 women (45%) were recalled for further assessment. A total of 71 cancers were detected, resulting in a positive predictive value (PPV) of 11.7%. Sensitivity and specificity of consensus review were 90% and 57%, respectively, with a negative predictive value of 99%. The benefit of consensus or arbitration has also been documented in a number of other screenfilm mammography studies (11-13). The vast majority of breast screening programs now use digital mammography. Few studies have looked at consensus outcomes following the introduction of full-field digital mammography (FFDM). We hypothesized that the introduction of digital mammography would have little impact on the sensitivity and specificity of consensus reading of screening mammograms.The primary objective of this study was to determine the outcomes of all women discussed at consensus review over a 5-year period after the introduction of digital
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