Current clinical practice in the management of phyllodes tumors of the breast: an international cross-sectional study among surgeons and oncologists

Abstract

Purpose Phyllodes tumors of the breast are rare fibroepithelial lesions that are classified as benign, borderline or malignant. There is little consensus on best practice for the work-up, management, and follow-up of patients with phyllodes tumors of the breast, and evidence-based guidelines are lacking. Methods We conducted a cross-sectional survey of surgeons and oncologists with the aim to describe current clinical practice in the management of phyllodes tumors. The survey was constructed in REDCap and distributed between July 2021 and February 2022 through international collaborators in sixteen countries across four continents. Results A total of 419 responses were collected and analyzed. The majority of respondents were experienced and worked in a university hospital. Most agreed to recommend a tumor-free excision margin for benign tumors, increasing margins for borderline and malignant tumors. The multidisciplinary team meeting plays a major role in the treatment plan and follow-up. The vast majority did not consider axillary surgery. There were mixed opinions on adjuvant treatment, with a trend towards more liberal regiments in patients with locally advanced tumors. Most respondents preferred a five-year follow-up period for all phyllodes tumor types. Conclusions This study shows considerable variation in clinical practice managing phyllodes tumors. This suggests the potential for overtreatment of many patients and the need for education and further research targeting appropriate surgical margins, follow-up time and a multidisciplinary approach. There is a need to develop guidelines that recognize the heterogeneity of phyllodes tumors.

Challenges and Clinical Relevance of Modern Breast Pathology Reporting: Your Questions Answered

“…The duration of follow-up needed after a patient is diagnosed with PT depends on the tumour grade [11]. A patient diagnosed with malignant PT would be referred for oncologic management, and usually treated based on sarcoma therapy principles, with follow-up by the oncology clinic [11]. For those with borderline PT, some institutions may consider radiotherapy after resection [11,12].…”

“…A patient diagnosed with malignant PT would be referred for oncologic management, and usually treated based on sarcoma therapy principles, with follow-up by the oncology clinic [11]. For those with borderline PT, some institutions may consider radiotherapy after resection [11,12]. For benign PT, there is no firm recommendation for clinical follow-up [13].…”

“…A survey conducted in the United Kingdom (UK) [14] and an international cross-sectional survey in sixteen countries across four continents [11] found a wide variation in follow-up practices for resected PT, and urged for evidence-based national guidelines to inform best practice. A 5-year follow-up period for all PTs is preferred among surgeons and oncologists in the international cross-sectional survey [11].…”

Malignant phyllodes tumor of the breast with predominant osteosarcoma and chondrosarcomatous differentiation: a rare case report and review of literature

“…The World Health Organization has subcategorized PTs into benign, borderline, and malignant categories on the basis of 5 histological parameters: stromal cellularity, stromal atypia, tumor margins, mitotic activity, and stromal overgrowth (3). MPTs are characterized by marked stromal cellularity, stromal growth, nuclear atypia, increased mitotic activity (≥10 per 10 high power fields), and infiltrative tumor margins (4). Moreover, the presence of heterologous sarcomatous elements such as osteosarcoma, chondrosarcoma, or liposarcoma within the tumor were frequently observed (5).…”