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NPJ Breast Cancer May 2023Large language models (LLM) such as ChatGPT have gained public and scientific attention. The aim of this study is to evaluate ChatGPT as a support tool for breast tumor...
Large language models (LLM) such as ChatGPT have gained public and scientific attention. The aim of this study is to evaluate ChatGPT as a support tool for breast tumor board decisions making. We inserted into ChatGPT-3.5 clinical information of ten consecutive patients presented in a breast tumor board in our institution. We asked the chatbot to recommend management. The results generated by ChatGPT were compared to the final recommendations of the tumor board. They were also graded independently by two senior radiologists. Grading scores were between 1-5 (1 = completely disagree, 5 = completely agree), and in three different categories: summarization, recommendation, and explanation. The mean age was 49.4, 8/10 (80%) of patients had invasive ductal carcinoma, one patient (1/10, 10%) had a ductal carcinoma in-situ and one patient (1/10, 10%) had a phyllodes tumor with atypia. In seven out of ten cases (70%), ChatGPT's recommendations were similar to the tumor board's decisions. Mean scores while grading the chatbot's summarization, recommendation and explanation by the first reviewer were 3.7, 4.3, and 4.6 respectively. Mean values for the second reviewer were 4.3, 4.0, and 4.3, respectively. In this proof-of-concept study, we present initial results on the use of an LLM as a decision support tool in a breast tumor board. Given the significant advancements, it is warranted for clinicians to be familiar with the potential benefits and harms of the technology.
PubMed: 37253791
DOI: 10.1038/s41523-023-00557-8 -
Journal of Thoracic Disease Nov 2016Phyllodes tumors of the breast are rare tumor types that consist of 0.3-1.0% in all breast tumors. The naming and classification of breast phyllodes tumor have been... (Review)
Review
Phyllodes tumors of the breast are rare tumor types that consist of 0.3-1.0% in all breast tumors. The naming and classification of breast phyllodes tumor have been debated for years. Based on the classification criteria modified by WHO in 2003, this review mainly introduced the clinicopathologic characteristics, pre-operational diagnosis and the treatment of breast phyllodes tumors, and also summarized the prognostic factors related to tumor recurrence.
PubMed: 28066617
DOI: 10.21037/jtd.2016.11.03 -
Cancer Management and Research 2019Phyllodes tumor is a very rare tumor of the breast, incidence being 0.3-0.9% of all breast tumors. Phyllodes tumors are classified into three grades: benign, borderline...
BACKGROUND
Phyllodes tumor is a very rare tumor of the breast, incidence being 0.3-0.9% of all breast tumors. Phyllodes tumors are classified into three grades: benign, borderline or malignant. The aim of this study was to investigate patient characteristics, imaging characteristic findings, surgical treatment and outcome of phyllodes tumor.
MATERIALS AND METHODS
This is a retrospective review of phyllodes tumor patients who had undergone surgical management between 1 January 2006 and 31 December 2015 in Head, Neck and Breast Unit, Department of Surgery, Chiang Mai University Hospital.
RESULTS
A total of 188 phyllodes tumor patients were included in this study. The average age of the patients was 35.6 years. The majority of the tumors were of lobulated shape. Tumor morphology from imaging: lobulated shaped tumor 112 cases, oval-shape 37 cases, round shape 8 cases and irregular 5 cases. Surgical management is the standard procedure for treatment of phyllodes tumors. A wide local excision was performed in 147 cases, mastectomy in 20 cases (modified radical mastectomy in 2 cases) and wide excision followed by mastectomy 21 cases. The final pathological diagnoses of the phyllodes tumors were: benign 118 cases (62%), borderline 33 cases (18%) and malignant in 37 cases (20%). The margin did not affect recurrence in all types.
CONCLUSION
The most frequent is a benign phyllodes tumor. Surgical treatment to remove the tumor with a free margin is acceptable with no recurrence difference from a wider margin. However, younger age and malignant phyllodes tumor are the two highest risk factors for recurrence.
PubMed: 31695485
DOI: 10.2147/CMAR.S215039 -
The Breast Journal 2022Phyllodes tumors (PTs) of the breast are rare fibroepithelial neoplasms, and factors associated with the recurrence of PTs are poorly understood. This study sought to...
PURPOSE
Phyllodes tumors (PTs) of the breast are rare fibroepithelial neoplasms, and factors associated with the recurrence of PTs are poorly understood. This study sought to identify clinicopathological factors associated with the recurrence of PTs.
METHOD
From January 2009 to December 2019, we identified 100 patients who underwent definitive surgery for PT. Clinicopathological risk factors associated with the recurrence of PT were assessed.
RESULTS
The median age of the patients was 44 y (range, 19-62 y), and the median tumor size was 4 cm (0.8-30 cm). At a median follow-up of 26.7 mo (0-103 mo), 22 of the 100 patients experienced local recurrence. In the univariate and multivariate analyses, body mass index ≥ 23 kg/m ( = 0.042 in the univariate analysis; = 0.039 in the multivariate analysis), tumor size ≥ 5 cm ( = 0.006 in the univariate analysis; = 0.036 in the multivariate analysis), and the presence of stromal overgrowth ( = 0.032 in the univariate analysis; = 0.040 in the multivariate analysis) were associated with an increased risk of local recurrence. Resection margins and grade were not associated with local recurrence.
CONCLUSION
Normal- or underweight patients and those with larger tumor sizes were more prone to local recurrence. Further larger, multicenter studies with a long-term follow-up are required.
Topics: Breast; Breast Neoplasms; Female; Follow-Up Studies; Humans; Margins of Excision; Neoplasm Recurrence, Local; Phyllodes Tumor; Retrospective Studies
PubMed: 35711882
DOI: 10.1155/2022/4474251 -
International Journal of Surgery Case... 2015Originally described in 1838 by Muller, phyllodes tumor is a rare fibroepithelial neoplasm which represents roughly 0.3-0.9% of all breast cancers. Phyllodes tumor are...
INTRODUCTION
Originally described in 1838 by Muller, phyllodes tumor is a rare fibroepithelial neoplasm which represents roughly 0.3-0.9% of all breast cancers. Phyllodes tumor are divided into benign, borderline and malignant histologic categories. Malignant phyllodes tumor represent anywhere from 10-30% of all phyllodes tumors. This group has both the potential to recur locally and metastasize, however not all malignant phyllodes behave this way. The challenge lays in predicting which tumor will recur locally or metastasize. Distinguishing this subset of malignant phyllodes tumor is paramount.
PRESENTATION OF CASE
We present a case of malignant phyllodes which presented with metastatic disease. What is fascinating about this case is not only the initial presentation but also the aggressiveness of this variation of phyllodes tumor. The patient initially presented with a large mass which encompassed her whole right breast. On surgical pathology the mass measured roughly 31cm in diameter and weighed over 10kg. Within 5 weeks from surgery the patient had suffered brain metastases and also 6 local recurrent tumors. The patient passed roughly 11 weeks after her first visit to our office.
CONCLUSION
Despite biopsy proven malignant phyllodes tumor, it was near impossible to predict such a rapid course of disease progression in our patient. Our case illustrates the unpredictable nature of this disease in general and it possibly sheds light on a variant of the disease which had undergone an aggressive transformation.
PubMed: 25697402
DOI: 10.1016/j.ijscr.2014.12.041 -
Cureus Sep 2023Introduction Phyllodes tumor (PT) is an uncommon fibroepithelial neoplasm of the breast. It is a biphasic tumor with stromal and epithelial components, with a tendency...
Introduction Phyllodes tumor (PT) is an uncommon fibroepithelial neoplasm of the breast. It is a biphasic tumor with stromal and epithelial components, with a tendency to recur. Because of its wide range of disease manifestations, it has been subclassified into three categories, i.e., benign, borderline, and malignant, based on several histological parameters. This study was conducted to evaluate the clinicopathological features associated with malignancy in breast PTs. Methods We conducted a retrospective study at the Department of Histopathology at Liaquat National Hospital, Karachi, Pakistan. A total of 146 biopsy-proven cases of PTs were enrolled in the study. Clinical data were obtained from the clinical referral forms. Specimens were obtained from either lumpectomy or simple mastectomy. The specimens obtained were received at the laboratory where after gross examination, paraffin-embedded tissue blocks were prepared, which were sectioned, stained, and studied by a senior histopathologist. Pathological features, such as mitotic count, necrosis, stromal atypia, stromal overgrowth, and heterologous elements, were observed. Based on these features, the PTs were classified into benign, borderline, and malignant tumors. Results The mean age of the PTs in our setup was 40.65 ± 12.17 years with a mean size of 9.40 ± 6.49 cm. Malignant PT was found to be the most prevalent in our population, accounting for 63 (43.2%) cases, followed by borderline (51, 34.9%) and benign (32, 21.9%). A significant association was found between the tumor subtype and patient age, i.e., patients diagnosed with malignant and borderline PTs were found to be of older age (mean 42.82 ± 12.94 and 42.05 ± 11.31 years, respectively) than those diagnosed with benign PTs (mean age 34.12 ± 9.75 years). Moreover, malignant PTs were associated with larger tumor size (mean 11.46 ± 6.08) compared with the other two subtypes. Conclusion We found a significant association among patient age, tumor size, and PT subtype. Therefore, apart from the usual histological parameters, patient age and tumor size are important parameters for predicting the behavior of breast PT and should be considered for management.
PubMed: 37908929
DOI: 10.7759/cureus.46168 -
Canadian Journal of Surgery. Journal... Feb 2019Phyllodes breast tumours are fairly uncommon, and they can be benign, borderline or malignant. General surgeons usually encounter them following the surgical excision of... (Review)
Review
Phyllodes breast tumours are fairly uncommon, and they can be benign, borderline or malignant. General surgeons usually encounter them following the surgical excision of a breast lump that had the appearance of a fibroepithelial lesion. The surgeon is then faced with the question of what to do to establish an acceptable treatment margin. In this discussion, we recommend a plan for the management of Phyllodes tumours based on a review of the recent literature, confirmed by a retrospective review of the results from our centre. A negative margin is acceptable treatment following a lumpectomy for Phyllodes tumours. Only patients with a positive margin should undergo a revision.
Topics: Adult; Breast Neoplasms; Cohort Studies; Female; Humans; Margins of Excision; Mastectomy, Segmental; Middle Aged; Neoplasm Recurrence, Local; Phyllodes Tumor; Prognosis; Rare Diseases; Retrospective Studies; Risk Assessment; Treatment Outcome
PubMed: 30694037
DOI: 10.1503/cjs.005718 -
International Journal of Surgery Case... 2018Malignant phyllodes tumor of the breast is an extremely rare entity usually presenting with similar clinical features with those of benign fibroadenoma. Due to its...
INTRODUCTION
Malignant phyllodes tumor of the breast is an extremely rare entity usually presenting with similar clinical features with those of benign fibroadenoma. Due to its scarcity and clinical presentation, it is quite difficult for clinicians to suspect and diagnose the disease at its early stage. There is currently no consensus regarding adjunctive radiotherapy, hormonal therapy and systemic chemotherapy recommended for malignant phyllodes tumors.
PRESENTATION OF CASE
This report presents a case of early-stage malignant phyllodes tumor treated by lumpectomy only without adjunctive chemoradiation therapy, but with an excellent outcome.
DISCUSSION
Early diagnosis and staging with high suspicion are crucial in malignant phyllodes tumor patients since they do not only improve the overall outcome of the disease after lumpectomy only but they also decrease morbidity and mortality with adjunctive chemoradiation therapy. This case report has been reported in line with the SCARE criteria (Agha et al., 2016 [1]).
PubMed: 29247967
DOI: 10.1016/j.ijscr.2017.12.013 -
Cureus May 2021Introduction Breast phyllodes tumor's (PT) clinical behavior is difficult to predict on histology. There is limited amount of data available on the role of biological...
Introduction Breast phyllodes tumor's (PT) clinical behavior is difficult to predict on histology. There is limited amount of data available on the role of biological markers. The objective of this study was to assess the expression of CD117 (c-KIT) in PT of the breast and its relationship with morphology and clinical outcome. Methods A total of 78 patients having available clinical records between 2004 and 2014 with breast PT were retrieved from the cancer registry at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore and were followed up. Immunohistochemical studies were performed on all the cases using mono-clonal antibody CD117 (DAKO A4502) using Leica Bond-Max automated biosystem (Leica Biosystems, Melbourne, Australia). Staining proportion and intensity of both epithelial and stromal elements were analyzed. Evaluation of the protein expression was determined and scored. Results Patients' mean age was 45.13 ± 11.4 years. Thirty-nine (50.0%) patients had tumor on right side, 38 (48.7%) had on left and only one (1.3%) was bilateral. Thirty-two (41.0%) patients had benign PT, 21 (26.9%) had borderline and 25 (32.1%) had malignant PT. Negative CD117 expression was observed in 20 (62.5%), eight (38.0%) and 12 (48.0%) of benign, borderline and malignant PTs, respectively. Positive CD117 expression was observed in 12 (37.5%) benign, 13 (61.9%) borderline and 13 (52.0%) malignant PTs. There was insignificant association between CD117 expression with respect to tumor sub-type, patient's age and clinical behavior (p-value > 0.05). Conclusion CD117 expression was not found to be associated with tumor type and was not associated with increased risk of recurrence in this sample of patients. Further work is needed to better understand the prognostic value of CD117 expression in breast PTs.
PubMed: 34123614
DOI: 10.7759/cureus.14914 -
Gland Surgery Feb 2023Grading based on histopathologic indicators cannot accurately assess the prognosis of phyllodes tumor (PT) of the breast. This article aimed to investigate the...
BACKGROUND
Grading based on histopathologic indicators cannot accurately assess the prognosis of phyllodes tumor (PT) of the breast. This article aimed to investigate the correlation between PT prognosis and clinicopathological features, treatment, and surgical margin.
METHODS
The clinicopathological data of patients with pathologically confirmed PT at our institution were retrospectively collected. Univariate and multivariate Cox proportional risk models were employed to test the effects of different variables on the prognosis of PT. A nomogram to predict the 1-, 3-, 5-, and 10-year recurrence-free survival (RFS) of PT was proposed, and its discriminative ability and calibration were tested using the concordance index (C-index), area under the curve (AUC), and calibration plots. All statistical analyses were performed using R.
RESULTS
A total of 342 PT patients were included, including 242 benign (70.8%), 75 borderline (21.9%) and 25 malignant (7.3%) cases. The median follow-up period was 64.5 months (range, 3-179 months), 66 PT patients had local recurrence (LR), and four patients had distant metastasis. The 1-, 3-, 5-, and 10-year RFS of the PT patients were 90.8%, 81.8%, 78%, and 76.7%, respectively. Age, fibroadenoma (FA) surgery history, treatment, mitotic activity, and surgical margin were selected as the independent factors for PT prognosis. The nomogram showed good discriminative ability and calibration, as indicated by the C-index [0.78, 95% confidence interval (CI): 0.75-0.11].
CONCLUSIONS
Independent predictors related to PT prognosis were selected to establish a nomogram for predicting the RFS of PT. This nomogram was able to objectively stratify PT patients into prognostic groups and performed well in the internal validation.
PubMed: 36915816
DOI: 10.21037/gs-22-542