Management and outcomes of phyllodes tumours – 10 year experience

Abstract

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.

Giant Phyllodes Tumor in an 82-Year-Old Female Initially Diagnosed a Fibroadenoma: A Case Report

“…The ability to distinguish between these two tumors preoperatively can not only aid in the intraoperative planning for determining proper excisional margins and management of the axilla but can also help to prevent overtreatment or undertreatment of the patient [ 4 , 5 ]. Wide surgical margins of at least 1 cm were originally thought to be optimal for local control [ 3 , 6 , 7 ]. Other studies have shown that the strongest predictor of local recurrence is the presence of tumor cells along the resection margin [ 3 , 6 , 7 ].…”

“…Wide surgical margins of at least 1 cm were originally thought to be optimal for local control [ 3 , 6 , 7 ]. Other studies have shown that the strongest predictor of local recurrence is the presence of tumor cells along the resection margin [ 3 , 6 , 7 ]. The ambiguity in surgical guidelines makes it difficult for the physician to decide the extent of resection for the tumor to best prevent local recurrence and avoid the need for another operation.…”

“…Its use remains controversial as studies have not demonstrated an increase in life expectancy in these cases [ 7 ]. Mastectomy has also been shown to decrease local recurrence rates, although breast-conserving surgery is preferred if possible, depending on the tumor grade and the breast-to-tumor ratio [ 3 , 4 ]. It is appropriate to exercise conservative management in benign and borderline phyllodes tumors and follow-up regularly postoperatively to screen for recurrence [ 7 ].…”

“…Phyllodes tumors are a rare type of fibroepithelial neoplasms of the breast typically occurring in women of ages 35-55 years, and accounting for approximately 0.3-0.9% of all primary breast neoplasms [1][2][3][4][5][6][7]. Phyllodes tumors and fibroadenomas are both included in the category of biphasic fibroepithelial lesions of the breast; fibroadenomas are far more common in clinical practice and constitute the majority of benign breast masses in younger women [2,[7][8][9].…”

Immunoexpression of human telomerase reverse transcriptase in fibroepithelial tumors of the breast

“…4,5 However, there are differences in therapy and prognosis in FAs and PTs. 6 Phyllodes tumors have several types of lesions with different clinical behavior, namely benign, borderline and malignant phyllode based on histopathological features that are in accordance with the classification of WHO recommendations. 1,7,8. There are several recent findings that significantly explain the pathomechanism of fibroepithelial tumors, and support FA as a pure neoplasm.…”