Phyllodes Tumor of the Breast: The Challenge Persists

Cheng, Shih‐Ping; Chang, Yuan‐Ching; Liu, Tsang-Pai; Lee, Jie-Jen; Tzen, Chin‐Yuan; Liu, Chien‐Liang

doi:10.1007/s00268-005-0786-2

Cited by 81 publications

(77 citation statements)

References 41 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%

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%

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

2016

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“…Malignant recurrence can be detected in 15-20% of benign or borderline phyllodes tumor recurrences (6,11). The principal factor affecting the risk of local recurrence in phyllodes tumors is attaining tumorfree surgical margins during surgery (6,12,13). Especially in borderline and malignant phyllodes tumors, the probability of local recurrence was reported as 21% even when surgical margins were tumor-free (14).…”

Section: Discussionmentioning

confidence: 99%

“…Local recurrence rates are higher in malignant phyllodes tumors, nevertheless, there is a risk of recurrence in patients with benign phyllodes tumor. Malignant recurrence can be detected in 15-20% of benign or borderline phyllodes tumor recurrences (6,11). The principal factor affecting the risk of local recurrence in phyllodes tumors is attaining tumorfree surgical margins during surgery (6,12,13).…”

Section: Discussionmentioning

confidence: 99%

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Analysis of patients with phylloides tumor of the breast

Atalay

Kınaş

Çelebioğlu

2014

UCD

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“…Genel sağkalımı ve sistemik metastazı etkileyen başlıca faktörler ise stromal aşırı gelişme bulgusu, pozitif cerrahi sı-nır ve sitonükleer atipidir (16)(17)(18). Hastalarımızın ortalama takip sü-resi 43 (5-95) ay olarak hesaplanmış olup bu süre zarfında memede nüks saptanmadı.…”

Section: Tartışma Ve Sonuçlarunclassified

Surgical Treatment of Phyllodes Tumors of the Breast: A Single Center Experience

Aksoy¹,

Gündeş²,

Vatansev³

et al. 2013

J Breasth Health

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Objective: Phyllodes tumor of the breast is a rare fibroepithelial tumor. In this study, our aim is to present the clinicopathological characteristics of our patients diagnosed with phyllodes tumor of the breast and our treatment approach to the cases. Materials and Methods:The medical records of a total of 9 patients who had been treated at our clinic between 2003 and 2011 for phyllodes tumor were analyzed retrospectively.Results: The median age of the patients was 38 (20-70) years. The presenting complaint of all patients was a palpable mass in the breast. Six of the patients were diagnosed by tru-cut biopsy, two were diagnosed through excisional biopsy, and one was diagnosed through fine-needle aspiration biopsy (FNAB). Median tumor size was 9.3 (4-20) cm. Local excision was performed on all but two patients so as to have the surgical border negative and no adjuvant additional treatment was initiated. Mastectomy was performed for one of the two patients and modified radical mastectomy was performed for the other. The follow-up period of the patients was an average of 43 (5-95) months. No breast recurrences were seen during the follow-up period.Conclusion: Pre-operative diagnosis is important for these cases in order to determine the surgical approach. It is difficult to differentiate these tumors from fibroadenoma by ultrasonography and mammography. It is possible to diagnose patients through tissue biopsy. In conclusion, a surgical approach with negative margins for all patients should be taken into consideration since phyllodes tumors are generally benign both clinically and pathologically.

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Phyllodes Tumor of the Breast: The Challenge Persists

Abstract: Breast-conserving surgery with clear margins is the current treatment of choice for phyllodes tumors, but this strategy does not further reduce local recurrence effectively. Optimal management continues to be a challenge.

Cited by 81 publications

References 41 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

Analysis of patients with phylloides tumor of the breast

Surgical Treatment of Phyllodes Tumors of the Breast: A Single Center Experience

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