Clinicopathologic Features and Long-Term Outcomes of 293 Phyllodes Tumors of the Breast

Abstract

Positive margins, fibroproliferation in the surrounding breast tissue, and necrosis are associated with a marked increase in LR rates. Efforts should be made to achieve negative surgical margins to reduce risk of LR. Death from PT is rare (2%), and only PT that demonstrate uniformly aggressive pathologic features seem to be associated with mortality.

Comparison of Clinical Characteristics Between Benign Borderline and Malignant Phyllodes Tumors of the Breast

“…On multivariate analysis, patients with bigger masses are more likely to be malignant (p=0.052, OR=1.127). A retrospective study carried out by Memorial SloanKettering Cancer Center in 2007 (Barrio et al, 2007) categorized phyllodes tumors into benign and malignant (including borderline and malignant) groups and tumor size into ≤3.0cm and >3.0cm, and they found malignant group was bigger than benign group (p<0.0001), so as another research done by Puay-Hoon Tan et al with p<0.001 (Tan et al, 2005).…”

“…We also noted a trend toward more excision cases in benign patients (p=0.018, OR=0.051). Apart from stromal hypercellularity, mitoses, cytologic atypia, stromal overgrowth and tumor borders, which are categorical standard items, several authors have noted (Tan et al, 2005;Barrio et al, 2007) other histological characteristics, such as necrosis, hemorrhage, cystic degeneration, intratumoral pseudoangiomatous stromal hyperplasia etc, are different in three histologic PTs. Our study aims to find the differences in clinical features between benign borderline and malignant phyllodes tumors, so we excludes count of mitosis in Ordinal Logistic Regression Analysis.…”

Benign and low-grade fibroepithelial neoplasms of the breast have low recurrence rate after positive surgical margins

“…10,13,16,21,25,26 Although some (13%) patients had no follow-up, the remaining patients had a median follow-up of 40.5 months, which is beyond the reported 12-36 month average time to recurrence. In addition, two of the three recurrences in our series occurred after 5 years.…”

“…14,15 Historically, incomplete excision of any phyllodes tumors has been correlated with local recurrences. 3,9,[16][17][18][19][20][21] However, many studies correlating positive or 'close' surgical margins with an increased risk of local recurrence do not separate benign or borderline phyllodes tumors from high grade, malignant phyllodes tumors. 16,17,20 In contrast, other studies have failed to demonstrate a direct relationship between margin status or width of negative margins and recurrence.…”

“…15,17 This may reflect multifocality of tumors, or the presence of associated 'fibroadenomatoid change' in the surrounding breast tissue. 21 Some authors have advocated a watchful waiting for patients with benign and low-grade tumors and positive surgical margins. 13,25 One potential downside to immediate re-excision is cosmetic; if another lesion that needs excision subsequently appears, a third resection would be necessary.…”