Recurrent Phyllodes Tumours of the Breast: Pathological Features and Clinical Implications

Tan, Ern Yu; Hoon, Tan Puay; Yong, Wei Sean; Wong, Hee-Kit; Hui, Ho G.; Yeo, Allen; Wong, Chow Yin

doi:10.1111/j.1445-2197.2006.03754.x

Cited by 74 publications

(45 citation statements)

References 17 publications

(67 reference statements)

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“…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.…”

Section: Discussionmentioning

confidence: 91%

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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: 91%

“…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.…”

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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“…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%

Analysis of patients with phylloides tumor of the breast

Atalay

Kınaş

Çelebioğlu

2014

UCD

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“…In addition, there are certain series in the literature that report recurrence in PT cases with negative margins at initial surgery (12,17). In their largest series, Zurrida et al advocated a wait-and-see policy for patients with benign and low-grade tumors and positive surgical margins, due to lower recurrence rates (25,26). In our series, we performed complete surgical resection with safe margins in clinically and radiologically suspected benign PTs or tumors of undetermined clinical significance.…”

Section: Discussionmentioning

confidence: 88%

“…The mean duration of time-to-recurrence varies in the literature, but most tumors recur within 2 years from diagnosis (20,21,(25)(26)(27). Therefore, it seems that most recurrences can be detected during this time frame with appropriate follow-up.…”

Section: Discussionmentioning

confidence: 99%

Is the extent of surgical resection important in patient outcome in benign and borderline phyllodes tumors of the breast?

Sevinç¹,

Aksoy²,

Durak³

et al. 2018

Turk J Med Sci

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Background/aim: Phyllodes tumors (PTs) of the breast are rare, and their diagnosis and treatment remain controversial. This retrospective study aims to examine the clinical outcome of benign and borderline PTs, according to the surgical margins. Materials and methods:We examined the medical records of 122 patients in our clinic, who had histologically confirmed benign and borderline PTs between 1994 and 2017. Results:The mean age of the patients was 40.6 years (range 18.0-81.0, ±12.1 standard deviation [SD]) and the mean tumor size was 25.8 mm (range 9-65, ±10.3 SD). All patients underwent a breast-conserving procedure and the median follow-up was 51 months. Tumor margins were positive (tumor touching the ink) in 43 patients (35%). Only 16 patients (13%) had margins ≥10 mm. The margins were between 2 and 10 mm in most patients (40%) and ≤1 mm in 12% of the patients. Conclusion:Although no re-excision was performed to obtain grossly clear margins, local recurrence was not observed in any patients. Therefore, revision surgery for close or positive surgical margins for benign and borderline PTs should not be performed as a rule. As most tumors recur within 2 years of diagnosis, we propose a close clinical and imaging follow-up during this period.

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Recurrent Phyllodes Tumours of the Breast: Pathological Features and Clinical Implications

Cited by 74 publications

References 17 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

Is the extent of surgical resection important in patient outcome in benign and borderline phyllodes tumors of the breast?

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