Surgical Management of Phyllodes Tumors

Mangi, Abeel A.; Smith, Barbara L.; Gadd, Michele A.; Tanabe, Kenneth K.; Ott, Mark J.; Souba, Wiley W.

doi:10.1001/archsurg.134.5.487

Cited by 192 publications

(167 citation statements)

References 24 publications

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“…2,3,4 Therefore, a preoperative diagnosis of phyllodes tumors is required to plan the extent of surgery. FNA is a commonly used first-line preoperative test in the investigation of palpable breast masses.…”

Section: Resultsmentioning

confidence: 99%

Cytological clues in the distinction between phyllodes tumor and fibroadenoma

Hag

Aodah

Kollur

et al. 2010

Cancer Cytopathology

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BACKGROUND: Fine-needle aspiration (FNA) sensitivity in discriminating between phyllodes tumor and its benign mimicker fibroadenoma (FA) remains low. Because a preoperative categorization of phyllodes tumor is crucial for their appropriate management, the authors undertook this study in an effort to improve the outcome of FNA by identifying reliable distinguishing features. METHODS: FNA smears from 15 and 12 histologically proven cases of phyllodes tumor and FA, respectively, were reviewed. The stromal and epithelial components were qualitatively and quantitatively analyzed. A group of cytological features that may distinguish between phyllodes tumor and FA were identified. Their value and reproducibility in categorizing phyllodes tumor cases were tested. RESULTS: Three major cytological features were exclusively seen in all of, or the vast majority of, the phyllodes tumor cases; fibromyxoid stromal fragments with spindle nuclei (90%), fibroblastic pavements (93%), and appreciable number of spindles cells of fibroblastic nature among dispersed cell population (100%). The identification of these features improved the pickup rate of phyllodes tumor from 40% to 100% and had substantial (j ¼ 0.56-0.73) interobserver and almost perfect (j ¼ 0.83) intraobserver reproducibility. There was no significant difference in the epithelial component characteristics between phyllodes tumor and FA. The frequency and degree of atypia in the dispersed cell population correlated well to the histological grade of phyllodes tumor. CONCLUSIONS: FNA has proven to be a reliable test in differentiating between phyllodes tumor and FA with high sensitivity and good reproducibility. The importance of training and continuing education is emphasized. Cancer (Cancer Cytopathol) 2010;118:33-40.

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Section: Resultsmentioning

confidence: 99%

Cytological clues in the distinction between phyllodes tumor and fibroadenoma

Hag

Aodah

Kollur

et al. 2010

Cancer Cytopathology

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“…Complete excision may be difficult, although re-excision to negative margins has been recommended. 7 In practice, the surgical management of positive margins after primary excision in patients with these low-grade fibroepithelial neoplasms is variable, and not all patients undergo re-excision. We hypothesize that the recommendation to excise phyllodes tumors to negative margins results in overtreatment of the subset of patients with benign phyllodes tumors.…”

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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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“…20 Surgery for phyllodes tumor is universally accepted as wide local excision with 1 cm margin, if preoperatively diagnosed while wait and watch policy for phyllodes tumor diagnosed after local excision of what appeared to be a fibroadenoma. 21,22 If recurrence is there then wide local excision should be done with proper margin clearance. Sometimes widespread chest wall disease can involve lung parenchyma, however very uncommon but palliation with radiotherapy and chemotherapy is done.…”

Section: Discussionmentioning

confidence: 99%