Phyllodes Tumors—The Predictors and Detection of Recurrence. Issue 2 (May 2021)

• Record Type: Journal Article
• Authors: Lim, Robert S.; Cordeiro, Erin; Lau, Jaqueline; Lim, Andrew; Roberts, Amanda; Seely, Jean
• Is Part Of: Canadian Association of Radiologists journal. Volume 72:Issue 2(2021)
• Page Start: 251
• Page End: 257
• Publication Date: 2021-05
• Subjects: phyllodes -- surgical excision -- tumor recurrence -- imaging; Radiology, Medical -- Periodicals; Radiology, Medical -- Canada -- Periodicals; 616.0757
• DOI: 10.1177/0846537119899553
• Languages: English
• ISSNs: 0846-5371

Abstract

Background: Phyllodes tumors are rare breast neoplasms and the histopathological grade and surgical margins help guide treatment and follow-up. The traditional surgical teaching is resection with ≥10 mm margins, but are narrower surgical margins acceptable? The purpose of our study was to identify predictors of local recurrence. Methods: A retrospective analysis was performed to identify patients with phyllodes tumors who underwent surgery between 2002 and 2014 using a regional pathology database. Electronic medical records were used to identify surgical management, pathological characteristics, and follow-up encounters. Results: A total of 150 phyllodes tumors were included: 110 of 150 (73%) benign, 21 of 150 (14%) borderline, and 19 of 150 (13%) malignant. At initial surgery, 29 specimens had a positive margin and 15 (56%) underwent re-excision. Seventy tumors had a surgical margin of ≤1 mm, 40 had a margin of 2 to 9 mm, and 11 had a margin of ≥10 mm. There were 11 of 150 (7.3%) locally recurrent tumors: 5 of 11 (45%) benign, 3 of 11 (27%) borderline, and 3 of 11 (27%) malignant. In total, 10 of 11 locally recurrent tumors had a positive margin or ≤1 mm margin at initial surgery. Conclusions: Phyllodes tumors can have a personalized treatment approach based on histopathological grade and surgical margins. Borderline and malignant phyllodes tumors with a positive or ≤1 mm surgical margin have an increased risk of recurrence. In benign phyllodes tumors, an optimal narrow negative margin may exist but the traditional ≥10 mm excisional margin is not necessary. Local recurrence rates may be sufficiently low in benign phyllodes tumors that imaging can be performed on the presence of clinical symptoms.