Surgical management and prognosis of phyllodes tumors of the breast

Abstract

Background: Regardless of histological grade, phyllodes tumors (PTs) exhibit the potential of local recurrence. The National Comprehensive Cancer Network (NCCN) recommends wide local excision (WLE) with a 1 cm margin or more for borderline/malignant PTs but excisional biopsy for benign PTs. However, the treatment of benign PTs remains controversial and the clinicopathologic risk factors for the local recurrence is still unclear. Methods: We retrospectively analyzed 238 patients with PTs who underwent surgery at the Chinese PLA General Hospital from January 1, 2006 and April 30, 2020. We stratified our analysis according to histologic grade and explored the clinicopathologic factors to influence local recurrence (LR), including age, histologic grade, history of fibroadenoma, type of surgery [vacuum-assisted biopsy system (VABS), local excision (LE), wide local excision (WLE) and mastectomy].Results: All 238 cases were categorized as benign (171, 71.8%), borderline (38, 16.0%), or malignant (29, 12.2%). The median follow-up was 50.2 months. In multivariate analysis, histologic grade (P<0.01) and history of fibroadenoma (P<0.01) were independent prognostic factors for LR. No difference existed in the recurrence rate of BPT treated with different surgical procedures (P=0.397), whereas a higher recurrence rate was found in VABS and LE subgroups than in WLE and mastectomy subgroups for borderline/ malignant tumors (P<0.01).Conclusions: No association found between surgical modalities and LR rate for BPT. We suggested a "wait-and-watch" policy for patients with unexpected benign subtypes, instead of unnecessary re-excision. In addition, VABS or LE can be treated for BPT with small mass, whereas WLE or even mastectomy should be conducted for borderline/malignant PTs with large mass.

Vacuum-assisted excision: a safe minimally invasive option for benign phyllodes tumor diagnosis and treatment—a systematic review and meta-analysis

“…Three studies (Chao et al., 2020, Vargas et al., 2006, and Ji et al., 2022) ( 11 , 12 , 19 ) did not present the Breast Imaging-Reporting and Data System (BI-RADS) classification of the lesions. Ouyang et al.…”

Margin status impact on recurrence of phyllodes tumors in high-risk groups: a retrospective observational study

“…Various studies have shown significant heterogeneity in margin management. Although older studies have recommended resection of tumors with wide margins [ 34 – 36 ], contemporary studies recommend a wait-and-watch approach [ 22 , 30 , 31 , 37 ]. In some studies, re-surgery in tumors with positive margins has been reported to have no effect on recurrence [ 20 ].…”

Predicting the recurrence-free survival of phyllodes tumor of the breast: a nomogram based on clinicopathology features, treatment, and surgical margin

“…Based on the inclusion and exclusion criteria, 342 patients were included in the analytic cohort. Among these, 238 patients were reported in our previous study (17). Only patients who underwent surgery in our hospital and were pathologically confirmed as PT were included.…”