Ann Surg Treat Res.  2023 Dec;105(6):353-359. 10.4174/astr.2023.105.6.353.

Is wide excision really needed? Correlation between resection margin and recurrence in benign phyllodes tumors of the breast

• Kim YJ
• Yun JH
• Hong SH
• Lee JE
• Han SW
• Kim SY

• KMID: 2548779
• DOI: http://doi.org/10.4174/astr.2023.105.6.353

Abstract

Purpose
Phyllodes tumors are similar to fibroadenomas in imaging and in pathological characteristics and are difficult to identify preoperatively. The purpose of this study was to analyze the recurrence rate after excision stratified by the surgical margin width and to propose and emphasize the “wait and watch” treatment strategy for benign phyllodes tumors.
Methods
We performed a retrospective cohort study of patients diagnosed with benign phyllodes tumors by surgical excision between January 2000 and December 2022 at our institution. The medical and histopathological records were reviewed.
Results
The results were obtained using the Cox proportional hazard regression and logistic regression. Resection margin status and recurrence were the independent variables. In each variable selection model, the resection margin was positive or less than 1 cm, and the recurrence rate was 3.7 and 1.04 times higher than the control group, but the difference was not statistically significant in 2 analyses.
Conclusion
The surgical resection margin status of benign phyllodes tumors did not significantly affect locoregional recurrence. Therefore, follow-up imaging at short intervals without additional surgery is a feasible clinical option when the surgical resection margin is positive or less than 1 cm.

Keyword

Breast neoplasms; Phyllodes tumor; Recurrence; Reoperation; Resection margin

Reference

1. Jang JH, Choi MY, Lee SK, Kim S, Kim J, Lee J, et al. Clinicopathologic risk factors for the local recurrence of phyllodes tumors of the breast. Ann Surg Oncol. 2012; 19:2612–2617. PMID: 22476816.

2. Chao TC, Lo YF, Chen SC, Chen MF. Sonographic features of phyllodes tumors of the breast. Ultrasound Obstet Gynecol. 2002; 20:64–71. PMID: 12100421.

3. Tan BY, Acs G, Apple SK, Badve S, Bleiweiss IJ, Brogi E, et al. Phyllodes tumours of the breast: a consensus review. Histopathology. 2016; 68:5–21. PMID: 26768026.

4. Gradishar WJ, Moran MS, Abraham J, Aft R, Agnese D, Allison KH, et al. NCCN Guidelines^® Insights: Breast Cancer, Version 4.2021. J Natl Compr Canc Netw. 2021; 19:484–493. PMID: 34794122.

5. Gradishar WJ, Anderson BO, Abraham J, Aft R, Agnese D, Allison KH, et al. Breast Cancer, Version 3.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2020; 18:452–478. PMID: 32259783.

6. Lu Y, Chen Y, Zhu L, Cartwright P, Song E, Jacobs L, et al. Local recurrence of benign, borderline, and malignant phyllodes tumors of the breast: a systematic review and meta-analysis. Ann Surg Oncol. 2019; 26:1263–1275. PMID: 30617873.

7. Genco IS, Purohit V, Hackman K, Ferreira L, Tugertimur B, Hajiyeva S. Benign and borderline phyllodes tumors of the breast: clinicopathologic analysis of 205 cases with emphasis on the surgical margin status and local recurrence rate. Ann Diagn Pathol. 2021; 51:151708. PMID: 33513547.

8. Lim RS, Cordeiro E, Lau J, Lim A, Roberts A, Seely J. Phyllodes tumors: the predictors and detection of recurrence. Can Assoc Radiol J. 2021; 72:251–257. PMID: 32090614.

9. Gradishar WJ, Moran MS, Abraham J, Aft R, Agnese D, Allison KH, et al. Breast Cancer, Version 3.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2022; 20:691–722. PMID: 35714673.

10. Yilmaz E, Sal S, Lebe B. Differentiation of phyllodes tumors versus fibroadenomas. Acta Radiol. 2002; 43:34–39. PMID: 11972459.

11. Lee AH, Hodi Z, Ellis IO, Elston CW. Histological features useful in the distinction of phyllodes tumour and fibroadenoma on needle core biopsy of the breast. Histopathology. 2007; 51:336–344. PMID: 17727475.

12. Barth RJ Jr. Histologic features predict local recurrence after breast conserving therapy of phyllodes tumors. Breast Cancer Res Treat. 1999; 57:291–295. PMID: 10617306.

13. Spitaleri G, Toesca A, Botteri E, Bottiglieri L, Rotmensz N, Boselli S, et al. Breast phyllodes tumor: a review of literature and a single center retrospective series analysis. Crit Rev Oncol Hematol. 2013; 88:427–436. PMID: 23871531.

14. Li J, Tsang JY, Chen C, Chan SK, Cheung SY, Wu C, et al. Predicting outcome in mammary phyllodes tumors: relevance of clinicopathological features. Ann Surg Oncol. 2019; 26:2747–2758. PMID: 31111353.

15. Barrio AV, Clark BD, Goldberg JI, Hoque LW, Bernik SF, Flynn LW, et al. Clinicopathologic features and long-term outcomes of 293 phyllodes tumors of the breast. Ann Surg Oncol. 2007; 14:2961–2970. PMID: 17562113.