Validation of the Singapore nomogram for outcome prediction in breast phyllodes tumours: an Australian cohort

Chng, Tze Wei; Lee, Jonathan Y H; Lee, C. Soon; Li, Huihua; Tan, Min‐Han; Tan, Puay Hoon

doi:10.1136/jclinpath-2016-203951

Cited by 28 publications

(15 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Chng et al suggested even not to reexcise borderline PT with positive surgical margins due to the absence of LR in their sample. However, their study was not representative enough as included only 7 cases with a short median follow-up of 20.4 months [38]. Our meta-analysis results support that the common practice of a 10 mm margin shows a clear reduction in rates of LR for borderline PT.…”

Section: Discussionsupporting

confidence: 53%

“…Moreover, some authors reported no increase of LR when the PT lesion was in contact with surgical margins [58]. Even further, other authors suggested no immediate re-excision and only a follow-up for benign PT when the surgical resection was in positive margins [6,38,64,65]. Our findings contest this advice, as we found that for benign PT the LR rate was 5.22 per 100 person-years with margins narrower than 10 mm and only 3.63 with margins at least 10 mm (i.e., a decrease of 30% of LR rate), over a 5-year period.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, positive margins would be associated with an increased rate of LR [7,11,14,15,26,31,[34][35][36]. On the other hand, some authors reported no recurrence for benign and borderline PT with involved margins [37,38]. Consequently, they concluded that reoperation with a wider resection in healthy tissue in case of positive margins was not justified [6].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Width of margins in phyllodes tumors of the breast: the controversy drags on?—a systematic review and meta-analysis

Toussaint

Piaget-Rossel

Stormacq

et al. 2020

Breast Cancer Res Treat

View full text Add to dashboard Cite

Purpose Phyllodes tumors (PT) of the breast are rare fibroepithelial neoplasms. Information is controversial in the literature regarding to the optimal surgical management. Most studies suggested margins of at least 10 mm while some recent studies suggested narrower margins without an increased risk of local recurrences (LR) and distant metastases (DM). The objective of this systematic review was to identify and compare studies that assessed these different practices. Methods A systematic review was performed through five databases up to April 2019. Studies exploring the association between the width of margins, subtypes of PT, and the LR and DM rates were considered for inclusion. A statistical model for analyzing sparse data and rare events was used. Results Thirteen studies met eligibility criteria and were selected. Considering a threshold of 10 mm (margins < 10 vs margins ≥ 10 mm), the 5-year incidence rate of LR was estimated to be 5.22 vs. 3.63 (diff. −1.59) per 100 person-years for benign PT, 9.60 vs. 7.33 (diff. −2.27) for borderline PT, and 28.58 vs. 21.84 (diff. −6.74) for malignant PT. For DM, it was estimated to be 0.88 vs. 0.86 (diff. −0.02) for benign PT, 1.61 vs. 1.74 (diff. 0.13) for borderline PT, and 4.80 vs 5.18 (diff. 0.38) for malignant PT. The data for a threshold of 1 mm were not sufficient to draw any conclusions. Conclusion Irrespective of tumor grade, we found that DM was a rarer event than LR. Malignant PT had the highest incidence rate of LR and DM. This meta-analysis found a clear association between width of margins and LR rates. Whatever the tumor grade, surgical margins ≥ 10 mm guaranteed a lower risk of LR than margins < 10 mm. On the other hand, the width of margin did not influence the apparition of DM.

show abstract

Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Width of margins in phyllodes tumors of the breast: the controversy drags on?—a systematic review and meta-analysis

Toussaint

Piaget-Rossel

Stormacq

et al. 2020

Breast Cancer Res Treat

View full text Add to dashboard Cite

show abstract

“…This nomogram was subsequently validated in two small case series [35,36]. Its widespread use in clinical practice is limited by the rarity of PTs in general.…”

Section: Factors Associated With Metastasismentioning

confidence: 99%

Distant metastases in phyllodes tumours of the breast: an overview

2017

Self Cite

View full text Add to dashboard Cite

Phyllodes tumours (PTs) of the breast are uncommon fibroepithelial neoplasms, comprising 0.3 -1.0% of all primary breast malignancies in Western countries, but accounting for a higher proportion of primary breast tumours in Asian countries. They are graded as benign, borderline or malignant based on the World Health Organisation (WHO) classification, according to a constellation of 5 histologic parameters. While most PTs carry a good prognosis, malignant and occasionally borderline PTs have the potential to metastasize to distant sites. Although events of distant metastasis are few, the prognosis for such patients is dismal, as they are often unresponsive to chemotherapy with high mortality. This review seeks to provide an overview of this rare but important phenomenon of distant metastases in PTs of the breast.

show abstract

“…These results again reflect difficulties in applying subjective criteria on a small amount of tissue, but also in applying them on potentially non-representative sampling of a tumour type that is often heterogeneous 15. And while it was reassuring that moderate digital point counting correlations between core and excision were observed, these might have been stronger if not for the established fact that FAs can have areas resembling PT and vice versa 15…”

Section: Discussionmentioning

confidence: 99%

Interobserver variation in the diagnosis of fibroepithelial lesions of the breast: a multicentre audit by digital pathology

et al. 2018

Self Cite

View full text Add to dashboard Cite

AimFibroepithelial lesions (FELs) of the breast span a morphological continuum including lesions where distinction between cellular fibroadenoma (FA) and benign phyllodes tumour (PT) is difficult. The distinction is clinically important with FAs managed conservatively while equivocal lesions and PTs are managed with surgery. We sought to audit core biopsy diagnoses of equivocal FELs by digital pathology and to investigate whether digital point counting is useful in clarifying FEL diagnoses.MethodScanned slide images from cores and subsequent excisions of 69 equivocal FELs were examined in a multicentre audit by eight pathologists to determine the agreement and accuracy of core needle biopsy (CNB) diagnoses and by digital point counting of stromal cellularity and expansion to determine if classification could be improved.ResultsInterobserver variation was high on CNB with a unanimous diagnosis from all pathologists in only eight cases of FA, diagnoses of both FA and PT on the same CNB in 15 and a ‘weak’ mean kappa agreement between pathologists (k=0.36). ‘Moderate’ agreement was observed on CNBs among breast specialists (k=0.44) and on excision samples (k=0.49). Up to 23% of lesions confidently diagnosed as FA on CNB were PT on excision and up to 30% of lesions confidently diagnosed as PT on CNB were FA on excision. Digital point counting did not aid in the classification of FELs.ConclusionAccurate and reproducible diagnosis of equivocal FELs is difficult, particularly on CNB, resulting in poor interobserver agreement and suboptimal accuracy. Given the diagnostic difficulty, and surgical implications, equivocal FELs should be reported in consultation with experienced breast pathologists as a small number of benign FAs can be selected out from equivocal lesions.

show abstract

Validation of the Singapore nomogram for outcome prediction in breast phyllodes tumours: an Australian cohort

Abstract: The Singapore nomogram is useful in predicting outcome in breast phyllodes tumours when applied to an Australian cohort of 34 women.

Cited by 28 publications

References 7 publications

Width of margins in phyllodes tumors of the breast: the controversy drags on?—a systematic review and meta-analysis

Width of margins in phyllodes tumors of the breast: the controversy drags on?—a systematic review and meta-analysis

Distant metastases in phyllodes tumours of the breast: an overview

Interobserver variation in the diagnosis of fibroepithelial lesions of the breast: a multicentre audit by digital pathology

Contact Info

Product

Resources

About