Benign and borderline phyllodes tumors of the breast: Clinicopathologic analysis of 205 cases with emphasis on the surgical margin status and local recurrence rate

Genco, Iskender Sinan; Purohit, Vaishali; Hackman, Kayla; Ferreira, Lisa; Tugertimur, Bugra; Hajiyeva, Sabina

doi:10.1016/j.anndiagpath.2021.151708

Cited by 13 publications

(6 citation statements)

References 16 publications

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“…Within our single institution, there was variability in follow-up, which may have been clinician dependent, with no standardised protocol. Such variation has also been highlighted nationally in a survey conducted by Amer et al, 10 reflecting a widespread lack of consensus and recommendations. 11 Based on thirteen years of experience in a large tertiary referral breast unit, clinical follow-up offers little benefit.…”

Section: Discussionmentioning

confidence: 98%

“…2,5,7,8 A tumour-free excision margin may reduce local recurrence; 9 however, the significance of clear margins or re-excision remains uncertain. 10 There is great variation in patients' surveillance protocols following the excision of PTs. 11 Few clinicians discharge patients immediately after surgical excision with many units having no local guidelines on PT follow-up.…”

Section: Introductionmentioning

confidence: 99%

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Benign and Borderline Phyllodes: Management and Follow-Up

2022

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Background: Phyllodes tumours of the breast are benign, borderline or malignant fibroepithelial lesions. They are uncommon and usually treated with surgical or radiological excision. The association with local recurrence has led to much debate over the extent of excision margins. It has traditionally followed that clinical surveillance for local recurrence is necessary following surgery. Follow-up is without any nationally agreed protocol and is therefore variable. Methods: After exclusions, 116 cases of benign (n=81), borderline (n=30) and malignant (n=5) phyllodes tumours were identified in a single centre, between 2005 and 2018. These were analysed using a database, electronic patient records and notes-based review. Results: Benign recurrence occurred in six patients with complete excision of benign PTs (7.4%) and one with borderline PT (3.3%). No malignant Phyllodes tumours developed following excision of benign or borderline lesions. Conclusions: This study of 13 years experience with 111 non-malignant Phyllodes tumours provides support for no routine clinical surveillance, but it supports patient education and open access to breast clinic.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Benign and Borderline Phyllodes: Management and Follow-Up

2022

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“…Although most surgeons are uncomfortable with PTs with a positive margin, it is reasonable for benign PTs to adopt “watch and wait” strategy. Recent findings suggest that close radiological and clinical follow-up may provide a better management process than re-excision when the margins of benign and borderline PTs are positive ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

Recurrent giant phyllodes tumor of the breast: a case report

Zhang,

Gan,

Zhao

et al. 2024

AME Case Rep

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Background Phyllodes tumors (PTs) account for 0.3–1.0% of all breast tumors and often occur in women aged 35 to 55. They are similar to giant fibroadenomas. PTs are famous for local recurrence. No more than 10% of PTs grow larger than 10 cm. The National Comprehensive Cancer Network (NCCN) guidelines recommend extensive resection with a margin of ≥1 cm for PTs, which is much larger than that required for breast cancer. Positive resection margin is associated with recurrence. However, little is known about whether all subtypes really require radical tumor negative resection margins. Case Description We report on a 49-year-old woman with a giant borderline PT in her left breast. The tumor was greater than 10.5 cm × 7.0 cm. She had a bilateral benign PT excision in January 2014 and a left benign PT excision in December 2018. A chest computerized tomography (CT) scan and abdomen ultrasound did not reveal distant metastasis. Therefore, left breast mastectomy was performed. Wound healing was satisfactory. Pathological and immunohistochemistry findings showed a borderline PT. Conclusions As the rare tumor of the breast, PTs pose a great challenge for surgeons. The initial evaluation of PTs relies on a triple evaluation of clinical, radiological, and histological examination. Local recurrence of PTs is more common than distant metastasis. The histology of recurrent tumors is usually identical to that of the primary tumor, or has a tendency to malignancy. Although most surgeons are uncomfortable with PTs with a positive margin, it is reasonable to adopt a “watchful waiting” strategy for benign PTs. The current recommendation that PTs should be extensively resected regardless of tumor size might be revised.

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“…PTs are treated by surgical excision in the first instance, although opinions differ on what constitutes an adequate margin 24 . Evidence suggests that benign PTs may not require “clear” margins, with low recurrence rates following enucleation 25–30 . On the other hand, malignant and recurrent PTs should be completely excised.…”

Section: Discussionmentioning

confidence: 99%

“…24 Evidence suggests that benign PTs may not require "clear" margins, with low recurrence rates following enucleation. [25][26][27][28][29][30] On the other hand, malignant and recurrent PTs should be completely excised. A systematic review found a relationship between the width of surgical margins and local recurrence as well as distant metastatic rates.…”

Section: Discussionmentioning

confidence: 99%

Survey of recurrent diagnostic challenges in breast phyllodes tumours

et al. 2022

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Background Breast phyllodes tumours (PTs) are graded as benign, borderline, or malignant by analysis of multiple histological features. PT grading is often inconsistent, likely due to variation in the weighting of grading criteria by pathologists. Design The hierarchy of use of diagnostic criteria was identified using a 20‐question survey. Results In all, 213 pathologists from 29 countries responded. 54% reported 10–50 PT cases per year. Criteria considered key to PT diagnosis were: increased stromal cellularity (84.3%), stromal overgrowth (76.6%), increased stromal mitoses (67.8%), stromal atypia (61.5%), stromal fronding (59.0%), periductal stromal condensation (58.0%), irregular tumour borders (46.3%), and/or lesional heterogeneity (33.7%). The importance of grading parameters were: mitotic activity (55.5%), stromal overgrowth (54.0%), stromal atypia (51.9%), increased stromal cellularity (41.7%), and nature of the tumour border (38.9%). 49% would diagnose malignant PT without a full array of adverse features. 89% used the term “cellular fibroepithelial lesion (FEL)” for difficult cases; 45% would diagnose an FEL with stromal fronding (but lacking other PT features) as fibroadenoma (FA), 35% FEL, and 17% PT. 59% deemed clinico‐radiological findings diagnostically significant; 68% considered age (≥40 years) important in determining if an FEL was a FA or PT. In FELs from young patients, increased stromal cellularity (83%), fronding (52%), and mitoses (41%) were more common. 34% regarded differentiating cellular FA from PT as a specific challenge; 54% had issues assigning a borderline PT grade. Conclusion Criteria for grading PT lie on a spectrum, leading to interpretive variability. The survey highlights the criteria most used by pathologists, which do not completely align with WHO recommendations.

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Benign and borderline phyllodes tumors of the breast: Clinicopathologic analysis of 205 cases with emphasis on the surgical margin status and local recurrence rate

Cited by 13 publications

References 16 publications

Benign and Borderline Phyllodes: Management and Follow-Up

Benign and Borderline Phyllodes: Management and Follow-Up

Recurrent giant phyllodes tumor of the breast: a case report

Survey of recurrent diagnostic challenges in breast phyllodes tumours

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