Clinicopathologic Risk Factors for the Local Recurrence of Phyllodes Tumors of the Breast

Jang, Jae Hyuck; Choi, Moon Young; Lee, Se Kyung; Kim, Sang-Min; Kim, Jiyoung; Lee, Jeonghui; Jung, Seung Pil; Choe, Jun Ho; Kim, Jung Han; Kim, Jee Soo; Cho, Eun Yoon; Lee, Jeong Eon; Nam, Seok Jin; Yang, Jung Hyun

doi:10.1245/s10434-012-2307-5

Cited by 122 publications

(102 citation statements)

References 29 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

2016

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Breast phyllodes tumors are uncommon fibroepithelial neoplasms with a range of histologic features. Surgical excision is the primary management, but the need for excision to negative margins in benign and borderline phyllodes tumors is unclear. Here, we review the surgical management patterns and outcomes of 90 patients with benign and low-grade fibroepithelial lesions of the breast treated at our institution, including 19 borderline phyllodes tumors, 52 benign phyllodes tumors, and 19 representative neoplasms with overlapping features of fibroadenoma and benign phyllodes tumors, which were classified as 'fibroadenomas with phyllodal features'. In total, 52 (58%) had positive surgical margins on first excision, and of these 17 (33%) underwent re-excision to achieve negative margins. Residual tumor was identified in three (18%) re-excisions. Patients with fibroadenoma with phyllodal features were more likely to have a positive surgical margin than with benign phyllodes tumors or borderline phyllodes tumors (89 vs 49%, P = 0.0015), and were less likely to undergo re-excision for positive margins (12 vs 43%, P = 0.031). In total, there were three recurrences (3%), with one per fibroadenoma with phyllodal features, benign phyllodes tumor, and borderline phyllodes tumor. There was no statistically significant difference in recurrence rates between patients with positive or negative margins, or between patients with positive margin with or without re-excision. The extent of the positive margin did not predict recurrence. In conclusion, the recurrence rate of benign and low-grade fibroepithelial lesions is low and not associated with the original margin status. Patients with fibroadenomas with phyllodal features, benign phyllodes tumors, or selected borderline phyllodes tumors and positive margins on initial excision may be managed conservatively, with close follow-up and timely re-excision of any potential recurrence.

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Section: Discussionmentioning

confidence: 99%

“…22 In a study of 164 phyllodes tumors, a 1-cm wide margin showed no advantage over a narrower negative margin. 20 23 or margin status 24 and local disease recurrence. Additional series have also documented recurrences in phyllodes tumors that were originally excised to negative margins.…”

Section: Discussionmentioning

confidence: 99%

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

2016

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“…Distant metastasis, mostly through hematogenous route is found in approximately 25% of patients with malignant phylloides tumor and the dissemination is cheifly determined by the biological behavior of the tumor. The commonest sites for distant metastasis are the lungs (66%), bones (28%), and brain (9%) and in rare instances, the liver and heart [7]. Metastasis to axillary lymph nodes occurred in only 2% [8].…”

Section: Discussionmentioning

confidence: 99%

Recurrent Malignant Phylloides Tumor: A Rare Entity

Malik¹,

Gupta²

2015

J Cytol Histol

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Phylloides tumor of breast is a rare tumor of fibroepithelial origin forming only about 0.3-0.5% of all breast malignancies. Malignant phylloids tumor is even more rarely encountered lesion of very unpredictable clinical outcome with high chances of recurrence and distant metastasis. Accurate preoperative pathological diagnosis is mandatory to allow correct planning of the surgical treatment which can be either wide excision or mastectomy with an intent to have a negative surgical margin of at least 1 cms. This rare and enigmatic tumor should be kept in mind while dealing with breast lumps. Here, we present a case of recurrent malignant phylloides tumor in a young female alongwith review of literature of this rare entity. Aim and Objective:To present a case of recurrent malignant phylloides tumor in a young female alongwith its cytology images and to have a review of literature of this enigmatic entity.

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“…[8,25,31,39,43] Studies reporting tumor size <5 cm as the significant cutoff have median tumor size in the range of 3.0-6.1 cm. [24,27,31,37] The hazard ratio (HR) has not been reported in most of the studies except in the study by Asoglu et al, where authors have demonstrated tumor size to be an independent predictor of LR in multivariate analysis. [24] Tumor diameter >5 cm was associated with a 4-fold increase in LR (p = 0.0177).…”

Section: Histological Classificationmentioning

confidence: 99%

“…[8,9,24,25,[32][33][34][35][36][37][38][39][40] The incidence of local failure is higher when margin is positive rather than close. It is important to note that the definition of negative margins (i.e., 1 cm) has been arbitrarily derived from the retrospective studies.…”

Section: Histological Classificationmentioning

confidence: 99%

Phyllodes tumor of the breast: Wolf inside the sheep’s skin!

Wadasadawala¹,

Swain²,

Bajpai³

2016

Oncobiology and Targets

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Phyllodes tumor, previously known as cystosarcoma phyllodes, is a rare fibro-epithelial tumor of breast constituting <1% of all the breast tumors. It is classified into benign, borderline, and malignant subtypes depending upon the histological criteria defined by the World Health Organization and also has an independent prognostic significance. Accurate pretreatment histological diagnosis is important for the optimal management of phyllodes tumor so that low recurrence rates, improved survival, and optimal long-term cosmetic result can be achieved. Despite surgery being the standard of care, the best type of surgery for each histological type is yet to be defined. The higher rate of local recurrence after surgery alone in borderline and malignant phyllodes tumor raises the question regarding the need of adjuvant treatment, especially radiotherapy, which remains underutilized. The perspective of the current review is to provide the state-of-the-art management of phyllodes tumor of the breast and highlight the risk factors associated with recurrence.

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Clinicopathologic Risk Factors for the Local Recurrence of Phyllodes Tumors of the Breast

Cited by 122 publications

References 29 publications

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

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

Recurrent Malignant Phylloides Tumor: A Rare Entity

Phyllodes tumor of the breast: Wolf inside the sheep’s skin!

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