Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 10/2017

01-10-2017 | Breast Oncology

Association Between Recurrence and Re-Excision for Close and Positive Margins Versus Observation in Patients with Benign Phyllodes Tumors

Authors: Tracy-Ann Moo, MD, Hanan Alabdulkareem, MD, Andrew Tam, MD, Constance Fontanet, MS, Yao Lu, MS, Alyssa Landers, MA, Timothy D’Alfonso, MD, Rache Simmons, MD

Published in: Annals of Surgical Oncology | Issue 10/2017

Login to get access

Abstract

Background

Breast lesions not sampled prior to surgery or initially diagnosed as fibroepithelial lesions on core biopsy may have a diagnosis of phyllodes tumor (PT) on excision. Historically, re-excision for close or positive margins has been the standard of care. We examined the rate of re-excision for close or positive margins in patients with benign phyllodes and compared recurrence rates among those undergoing re-excision versus observation.

Methods

We identified all patients with phyllodes tumor diagnosed between 2003 and 2013. Operative and surgical pathology reports were reviewed for clinical, pathologic, and follow-up data.

Results

Among 246 cases, 216 (88%) were benign PT and 30 (12%) borderline/malignant tumors. In the group of benign PT (n = 216), margins were negative in 64 patients (29.6%), 50 (23%) were close, and 102 (47%) were positive. Of those with close margins, 22 (44%) underwent reexcision and residual benign PT was found in 2 (9%). In patients with positive margins, 45 (44%) had re-excision and residual benign PT was detected in 4 (8.8%). After a median follow-up of 35.5 months, there were 4 (1.9%) recurrences among patients with benign PT. There was no difference in recurrence among patients who had re-excision for positive or close margins versus observation (p = 0.7 and 0.21, respectively).

Conclusions

Among patients with close or positive margins, there was no significant difference in disease recurrence between patients who underwent reexcision and those who were observed. Based on these results, it may be reasonable to manage these patients conservatively with close follow-up.
Literature
1.
Bernstein L, Deapen D, Ross RK. The descriptive epidemiology of malignant cystosarcoma phyllodes tumors of the breast. Cancer. 1993;71:3020–24.CrossRefPubMed
2.
Wiratkapun C, Piyapan P, Lertsithichai P, Larbcharoensub N. Fibroadenoma versus phyllodes tumor: distinguishing factors in patients diagnosed with fibroepithelial lesions after a core needle biopsy. Diagn Interv Radiol Ank Turk. 2014;20:27–33.
3.
Cowan ML, Argani P, Cimino-Mathews A. Benign and low-grade fibroepithelial neoplasms of the breast have low recurrence rate after positive surgical margins. Mod Pathol. 2016;29:259–65.CrossRefPubMed
4.
Mangi AA, et al. Surgical management of phyllodes tumors. Arch Surg Chic Ill 1960. 1999;134:487–493.
5.
6.
Chaney AW, et al. Primary treatment of cystosarcoma phyllodes of the breast. Cancer. 2000;89:1502–11.CrossRefPubMed
7.
Kapiris I, Nasiri N, A’Hern R, Healy V, Gui GP. Outcome and predictive factors of local recurrence and distant metastases following primary surgical treatment of high-grade malignant phyllodes tumours of the breast. Eur J Surg Oncol. 2001;27:723–30.CrossRefPubMed
8.
Borhani-Khomani K, Talman M-LM, Kroman N, Tvedskov TF. Risk of local recurrence of benign and borderline phyllodes tumors: a Danish population-based retrospective study. Ann Surg Oncol. 2016;23:1543–58.CrossRefPubMed
9.
Kim S, Kim J-Y, Kim DH, Jung WH, Koo JS. Analysis of phyllodes tumor recurrence according to the histologic grade. Breast Cancer Res Treat. 2013;141:353–63.CrossRefPubMed
10.
Yom CK, et al. Reappraisal of conventional risk stratification for local recurrence based on clinical outcomes in 285 resected phyllodes tumors of the breast. Ann Surg Oncol. 2015;22:2912–8.CrossRefPubMed
11.
Gradishar WJ, et al. Invasive Breast Cancer Version 1.2016, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Cancer Netw. 2016;14:324–54.CrossRef
12.
Reinfuss M, et al. The treatment and prognosis of patients with phyllodes tumor of the breast: an analysis of 170 cases. Cancer. 1996;77:910–16.CrossRefPubMed
13.
Pietruszka M, Barnes L. Cystosarcoma phyllodes: a clinicopathologic analysis of 42 cases. Cancer. 1978;41:1974–83.CrossRefPubMed
14.
Tan EY, et al. Recurrent phyllodes tumours of the breast: pathological features and clinical implications. ANZ J Surg. 2006;76:476–80.CrossRefPubMed
15.
Tan PH, et al. Predicting clinical behaviour of breast phyllodes tumours: a nomogram based on histological criteria and surgical margins. J Clin Pathol. 2012;65:69–76.CrossRefPubMed
16.
Barth RJJ. Histologic features predict local recurrence after breast conserving therapy of phyllodes tumors. Breast Cancer Res Treat. 1999;57:291–5.CrossRefPubMed
17.
Barrio AV, et al. Clinicopathologic features and long-term outcomes of 293 phyllodes tumors of the breast. Ann Surg Oncol. 2007;14:2961–70.CrossRefPubMed
18.
Jang JH, et al. Clinicopathologic risk factors for the local recurrence of phyllodes tumors of the breast. Ann Surg Oncol. 2012;19:2612–17.CrossRefPubMed
19.
Onkendi EO, et al. Surgical treatment of borderline and malignant phyllodes tumors: the effect of the extent of resection and tumor characteristics on patient outcome. Ann Surg Oncol. 2014;21:3304–09.CrossRefPubMed
20.
Lin C-C, Chang H-W, Lin C-Y, Chiu C-F, Yeh S-P. The clinical features and prognosis of phyllodes tumors: a single institution experience in Taiwan. Int J Clin Oncol. 2013;18:614–20.CrossRefPubMed
21.
22.
Spitaleri G, et al. Breast phyllodes tumor: a review of literature and a single center retrospective series analysis. Crit Rev Oncol Hematol. 2013;88:427–36.CrossRefPubMed
23.
Tan P-H, et al. Phyllodes tumors of the breast: the role of pathologic parameters. Am J Clin Pathol. 2005;123:529–40.CrossRefPubMed
24.
Metadata
Title
Association Between Recurrence and Re-Excision for Close and Positive Margins Versus Observation in Patients with Benign Phyllodes Tumors
Authors
Tracy-Ann Moo, MD
Hanan Alabdulkareem, MD
Andrew Tam, MD
Constance Fontanet, MS
Yao Lu, MS
Alyssa Landers, MA
Timothy D’Alfonso, MD
Rache Simmons, MD
Publication date
01-10-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 10/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-017-5955-7

Other articles of this Issue 10/2017

Annals of Surgical Oncology 10/2017 Go to the issue

Breast Oncology

Localizing the Clipped Node in Patients with Node-Positive Breast Cancer Treated with Neoadjuvant Chemotherapy: Early Learning Experience and Challenges

Breast Oncology

Expanded Gene Panel Use for Women With Breast Cancer: Identification and Intervention Beyond Breast Cancer Risk

Breast Oncology

Preoperative Panel Testing for Hereditary Cancer Syndromes Does Not Significantly Impact Time to Surgery for Newly Diagnosed Breast Cancer Patients Compared with BRCA1/2 Testing

Breast Oncology

Contralateral Prophylactic Mastectomy with Immediate Breast Reconstruction Increases Healthcare Utilization and Cost

Breast Oncology

Breast Cancer Disparities: Socioeconomic Factors versus Biology

Breast Oncology

Improved Locoregional Control in a Contemporary Cohort of Nonmetastatic Inflammatory Breast Cancer Patients Undergoing Surgery