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Pathologica Apr 2022Phyllodes tumors (PT) are fibroepithelial neoplasms of the breast showing a peculiar leaf-like appearance. They account for 0.3 to 1% of all primary breast tumors and... (Review)
Review
Phyllodes tumors (PT) are fibroepithelial neoplasms of the breast showing a peculiar leaf-like appearance. They account for 0.3 to 1% of all primary breast tumors and 2.5% of all fibroepithelial breast tumors. PT are classified into benign, borderline and malignant based upon their stromal morphology with a distribution of 60%, 20%, and 20%, respectively. Malignant PT of the breast constitute an uncommon challenging group of fibroepithelial neoplasms. They have a relatively high tendency to recur, although distant metastasis is uncommon, and nearly exclusive to malignant PT. Adequate surgical resection remains the standard approach to achieve maximal local control. Giant malignant PT are rare and a pose a diagnostic dilemma for pathologists, especially when comprised of sarcomatous elements. This review highlights the morphological features of PT detected in cytology and histology specimens and discusses diagnostic pitfalls and differential diagnosis.
Topics: Breast; Breast Neoplasms; Female; Humans; Neoplasm Recurrence, Local; Neoplasms, Fibroepithelial; Phyllodes Tumor
PubMed: 35414723
DOI: 10.32074/1591-951X-754 -
International Journal of Surgery... Nov 2022Phyllodes tumor is rare but has a high recurrence rate. Treatment modalities and clinicopathological prognostic factors for recurrence remain unclear. The synthesis of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Phyllodes tumor is rare but has a high recurrence rate. Treatment modalities and clinicopathological prognostic factors for recurrence remain unclear. The synthesis of real-world data can enable the integration of sufficient evidence on optimal treatment for this population.
METHODS
We searched PubMed, Embase, and Cochrane Library databases for studies focusing on the management of phyllodes tumor including the surgical margin, different clinicopathological prognostic factors, and postoperative adjuvant radiotherapy versus no radiotherapy.
RESULTS
Fifty-two studies were retrieved. The pooled estimated recurrence rates of benign, borderline, and malignant tumors were 7.1%, 16.7%, and 25.1%, respectively. Surgical margins of 1 mm (odds ratio [OR]: 0.4, 95% confidence interval [CI]: 0.27-0.61) and 1 cm (OR: 0.45, 95% CI: 0.15-0.85) resulted in significantly higher recurrence rates. Postoperative adjuvant radiotherapy significantly reduced the recurrence rate of malignant tumors relative to no radiotherapy (P = 0.034) but did not significantly reduce the recurrence rates of overall and borderline tumors. Regarding clinicopathological features, moderate or severe stromal atypia and hypercellularity, stromal overgrowth, mitotic number of 5, tumor necrosis, tumor border, and margin status were determined as independent prognostic factors for recurrence, except a tumor size of 5 cm.
CONCLUSION
The ideal surgical margin for phyllodes tumor incision should be at least 1 cm in width. Adjuvant radiotherapy reduced the recurrence of malignant tumor. By identifying patients with poor clinicopathological risk factors, surgeons may reduce the recurrence rate of phyllodes tumor.
Topics: Humans; Female; Phyllodes Tumor; Margins of Excision; Neoplasm Recurrence, Local; Radiotherapy, Adjuvant; Adjuvants, Immunologic; Breast Neoplasms; Prognosis; Retrospective Studies
PubMed: 36328344
DOI: 10.1016/j.ijsu.2022.106969 -
The American Surgeon Dec 2023Metastatic, malignant phyllodes tumor (PT) of the breast is a rare and aggressive neoplasm. Currently, there is no agreed upon consensus as to best management practices.... (Review)
Review
Metastatic, malignant phyllodes tumor (PT) of the breast is a rare and aggressive neoplasm. Currently, there is no agreed upon consensus as to best management practices. A systematic review of literature was conducted investigating surgical, chemotherapeutic, and radiotherapeutic management for metastatic PT. Databases employed to identify articles included Embase, PubMed, and SAGE Journals. Diagnosis of metastatic PT has been of significant difficulty to radiologists as it is often confused with fibroadenomas. Surgically, metastatectomy has been correlated with increased overall survival (of 25.9 versus 9.9 months; = .01). Radiotherapy has often been associated with palliation and pain control in metastatic, malignant neoplasia. However, one study showed that in malignant PT, radiation was associated with significantly lower rates of local recurrence (OR: 0.048 versus 0.209). Anthracycline containing chemotherapy regimens has been associated with improved overall survival (22.4 months versus 13.2 months; = .040). Further research must be conducted into this rare malignancy to elucidate accurate diagnosis and care for patients with advanced metastatic or malignant phyllodes tumors.
Topics: Humans; Female; Phyllodes Tumor; Breast; Neoplasm Recurrence, Local; Breast Neoplasms; Retrospective Studies
PubMed: 37611540
DOI: 10.1177/00031348231198114 -
Archives of Iranian Medicine Jul 2020Phyllodes tumor (PT) is a rare tumor of the breast, which may occur during pregnancy or lactation. Several studies have reviewed and discussed PT occurring in pregnancy,...
BACKGROUND
Phyllodes tumor (PT) is a rare tumor of the breast, which may occur during pregnancy or lactation. Several studies have reviewed and discussed PT occurring in pregnancy, gathering up to 14 patients. We performed a thorough systematic review of the literature in an attempt to find all reported cases, and identify their common characteristics.
METHODS
We searched Google scholar, PubMed, Ovid Medline, Scopus and ClinicalTrials.gov with several relevant combinations of keywords, looking for texts or abstracts without any date or language limitations, but using only English keywords. The existing literature only consisted of case reports and series; therefore any paper including one or several cases of PT presenting during pregnancy or breastfeeding was recognized as eligible. Articles with vague description of the tumor which made the diagnosis uncertain, and those lacking data about the tumor and management data were excluded. We contacted authors for more details in cases with incomplete information.
RESULTS
After excluding those with very deficient data, we included 37 studies, counting 43 cases. The mean age of the patients was 31 years (21-43 years). Some features were different from usual PT: bilaterality (16.2%), large size (14.2 ± 8.6 cm), rapid enlargement (79.5%), and rate of malignancy (60.5%).
CONCLUSION
Our findings show high rates of bilaterality, large size, rapid growth, and malignant pathology in the reported gestational PTs.
Topics: Breast Neoplasms; Female; Humans; Lactation; Mastectomy; Phyllodes Tumor; Pregnancy; Pregnancy Complications, Neoplastic
PubMed: 32657600
DOI: 10.34172/aim.2020.46 -
Oncology Letters Oct 2022The objective of the present systematic review was the determination of methodologies preferable for treating phyllodes tumors (PTs) of the breast and whether the...
The objective of the present systematic review was the determination of methodologies preferable for treating phyllodes tumors (PTs) of the breast and whether the malignancy of the tumor is of significance to the selected treatment. In addition, to investigate if local recurrence (LR) within patients is different based on the therapeutic approach followed by the physician. All studies were gathered by utilization of the biggest online medical databases in the world including PubMed, Cochrane, Embase, Web of Science and Google Scholar. Due to the specificity of the study, the resultant set of studies included in the present analysis was not large. All included studies had to refer to patients diagnosed with PTs of the breast, include the malignancy of the tumor and the preferred treatment. Moreover, they included a reference to LR post-treatment, even if there wasn't any. The age range of patients was 20-55 years old and follow-ups should have been performed. As a result, from the initial 484 studies gathered and after proper and thorough evaluation, only 10 were of significance. The studies appeared heterogeneous in terms of population, topology, treatment methodology, additional therapeutic approaches, LR rate, age and follow-up periods. Overall, excisions were used for non-malignant tumors while mastectomy was preferable for tumors with malignancy. Radiotherapy was used both as an additional treatment for tumors and LR. Also, it was revealed that LR varied based on the malignancy and treatment methodology.
PubMed: 36168312
DOI: 10.3892/ol.2022.13473 -
Frontiers in Oncology 2024This is a systematic review and meta-analysis comparing surgical excision with percutaneous ultrasound-guided vacuum-assisted excision (US-VAE) for the treatment of...
SYNOPSIS
This is a systematic review and meta-analysis comparing surgical excision with percutaneous ultrasound-guided vacuum-assisted excision (US-VAE) for the treatment of benign phyllodes tumor (PT) using local recurrence (LR) as the endpoint.
OBJECTIVE
To determine the frequency of local recurrence (LR) of benign phyllodes tumor (PT) after ultrasound-guided vacuum-assisted excision (US-VAE) compared to the frequency of LR after surgical excision.
METHOD
A systematic review and meta-analysis [following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard] was conducted by comparing LR in women older than 18 years treated for benign PT by US-VAE compared with local surgical excision with at least 12 months of follow-up. Studies were retrieved from PubMed, Scopus, Web of Science, and Embase. The pooled effect measure used was the odds ratio (OR) of recurrence.
RESULTS
Five comparative prospective or retrospective observational studies published between January 1, 1992, and January 10, 2022, comparing surgical excision with percutaneous US-VAE for LR of benign PT met the selection criteria. Four were retrospective observational cohorts, and one was a prospective observational cohort. A total of 778 women were followed up. Of them, 439 (56.4%) underwent local surgical excision, and 339 (43.6%) patients had US-VAE. The median age of patients in the five studies ranged from 33.7 to 39 years; the median size ranged from 1.5 cm to 3.0 cm, and the median follow-up ranged from 12 months to 46.6 months. The needle gauge ranged from 7G to 11G. LR rates were not statically significant between US-VAE and surgical excision (41 of 339 34 of 439; OR 1.3; p = 0.29).
CONCLUSION
This meta-analysis suggests that using US-VAE for the removal of benign PT does not increase local regional recurrence and is a safe minimally invasive therapeutic option.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, identifier CRD42022309782.
PubMed: 38807769
DOI: 10.3389/fonc.2024.1394116 -
European Journal of Breast Health Jul 2023To summarize the evidence on the current management and outcomes for metastatic and recurrent malignant phyllodes tumors (MPTs) of the breast. A systematic literature...
To summarize the evidence on the current management and outcomes for metastatic and recurrent malignant phyllodes tumors (MPTs) of the breast. A systematic literature review of all cases of metastatic or recurrent MPTs of the breast published between 2010 and 2021 was performed. In total, 66 patients from 63 articles were included. Fifty-two (78.8%) had distant metastatic disease (DMD subgroup), and 21 (31.8%) showed locoregional recurrent/progressive disease (LRPR subgroup). Locoregional recurrences in patients with no distant metastases were treated with surgical excision in all cases. Radiotherapy was administered in 8/21 cases (38.1%) and was combined with chemotherapy in 2/21 cases (9.5%). Metastatic disease was managed through metastases surgical excision, chemotherapy, radiotherapy, or a combination of these three in 84.6% of cases, while the remaining patients received no oncological treatments. Chemotherapy was proposed in 75.0% of cases. Anthracycline and alkylating agent-based combination regimens were most frequently administered. The median survival time was 24 (2.0-152.0) months, and 72.0 (2.5-98.5) months in the DMD and LRPR subgroups, respectively. Management of recurrent or metastatic MPTs is challenging. Surgery is the fundamental approach, but the use of adjuvant radio- and chemo-therapy remains controversial due to the lack of scientific evidence. Further studies and international registers are needed to implement new and more efficient treatment strategies.
PubMed: 37415652
DOI: 10.4274/ejbh.galenos.2023.2023-3-2 -
Breast Cancer Research and Treatment Jan 2021Phyllodes tumors (PT) of the breast are rare fibroepithelial neoplasms. Information is controversial in the literature regarding to the optimal surgical management. Most... (Meta-Analysis)
Meta-Analysis Review
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.
Topics: Breast Neoplasms; Female; Follow-Up Studies; Humans; Margins of Excision; Neoplasm Recurrence, Local; Phyllodes Tumor; Retrospective Studies
PubMed: 32935237
DOI: 10.1007/s10549-020-05924-8 -
Annals of Surgical Oncology May 2019This systematic review and meta-analysis aimed to investigate local recurrence (LR) rates among the three grades (benign, borderline, and malignant) of phyllodes tumors... (Meta-Analysis)
Meta-Analysis
BACKGROUND
This systematic review and meta-analysis aimed to investigate local recurrence (LR) rates among the three grades (benign, borderline, and malignant) of phyllodes tumors (PTs). The study also assessed various risk factors for LR.
METHODS
Electronic articles published between 1 January 1995 and 31 May 2018, were searched and critically appraised. The authors independently reviewed the abstracts and extracted data for LR rates and LR risk factors.
RESULTS
The review incorporated 54 studies with 9234 individual cases. The pooled LR rates were 8% for benign, 13% for borderline, and 18% for malignant PTs. The risk of LR was significantly increased by borderline versus benign PTs (odds ratio [OR] 2.00; 95% confidence interval [CI] 1.68-2.38) and malignant versus borderline PTs (OR 1.28; 95% CI 1.05-1.55). The significant risk factors for LR were mitoses, tumor border (infiltrating vs. pushing), stromal cellularity (moderate/severe vs. mild), stromal atypia (severe vs. mild/absent), stromal overgrowth (severe vs. mild/absent), and tumor necrosis (positive vs. negative). Age and tumor size were not associated with LR risk. The subgroup analysis showed that breast-conserving surgery versus mastectomy and positive versus negative surgical margins were significantly associated with an increased LR risk only in malignant PTs.
CONCLUSIONS
The risk of LR was significantly increased from benign to borderline to malignant PTs. Mitoses, tumor border, stromal cellularity, stromal atypia, stromal overgrowth, tumor necrosis, type of surgery, and surgical margin status may be risk factors for LR. Different management strategies could be considered for different PT grades.
Topics: Breast Neoplasms; Female; Humans; Neoplasm Recurrence, Local; Phyllodes Tumor; Risk Factors
PubMed: 30617873
DOI: 10.1245/s10434-018-07134-5 -
Annals of the Royal College of Surgeons... Mar 2020Phyllodes tumours represent less than 1% of all UK breast neoplasms. Histological features allow classification into benign, borderline or malignant, which has a...
BACKGROUND
Phyllodes tumours represent less than 1% of all UK breast neoplasms. Histological features allow classification into benign, borderline or malignant, which has a significant impact on prognosis and recurrence. Currently, there is no consensus for the optimal surgical excision margin. This systematic review aims to provide a comparative summary of outcomes (local recurrence, metastasis and survival) for borderline and malignant phyllodes tumours resected with either ≥1cm or <1cm margins.
METHODS
MEDLINE and Embase were systematically searched (1990 to July 2019), in line with PRISMA guidelines. Study quality was assessed using the Newcastle-Ottawa scale.
RESULTS
Ten retrospective studies were included (Newcastle-Ottawa scale mean score: 5.6, range: 8-4). Nine reported local recurrence rates, four reported distant metastasis and four reported survival. Meta-analysis pooling demonstrated no statistically significant difference between <1cm and ≥1cm margins in terms of local recurrence rates (relative risk [RR] 1.43, 95% confidence interval [95% CI] 0.70 - 2.93; =0.33, =456), distant metastasis (RR 1.93, 95% CI 0.35 - 10.63; =0.45, =72) or mortality (RR 1.93, 95% CI 0.42 - 8.77; =0.40, =58) for borderline and malignant tumours. Additionally, two studies demonstrated no significant difference in local recurrence for borderline tumours excised with <0.1cm margins compared to ≥1cm.
CONCLUSION
Current evidence suggests that margins <1cm may provide adequate tumour excision. This could enable breast conservation in patients with smaller breast-to-tumour volume ratios, with improved cosmetic outcomes and patient satisfaction. A prospective, multi-institutional trial would be appropriate to further elucidate the safety of smaller margins.
Topics: Breast Neoplasms; Disease-Free Survival; Female; Humans; Margins of Excision; Neoplasm Metastasis; Neoplasm Recurrence, Local; Phyllodes Tumor; Survival Rate
PubMed: 31918563
DOI: 10.1308/rcsann.2019.0140