Elsevier

The Breast

Volume 38, April 2018, Pages 52-57
The Breast

Original article
A retrospective review of phyllodes tumours of the breast: A single institution experience

https://doi.org/10.1016/j.breast.2017.12.008Get rights and content

Highlights

  • •

    Phyllodes tumours are rare and diverse, posing challenges in prognosis and treatment.

  • •

    A single institution retrospective review was conducted.

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    Tumor necrosis is a significant negative prognostic factor for malignant disease.

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    Breast conserving surgery may be adequate for local control of malignant phyllodes tumours.

Abstract

Background

Phyllodes tumours are rare and histologically diverse, posing challenges in prognosis and treatment. Due to their rarity, they have seldom been studied.

Purpose

The purpose was to investigate clinical practices in the management of phyllodes tumours, as well as patient outcomes to contribute to the limited body of knowledge surrounding these tumours.

Methods

A retrospective review was conducted on all patients with phyllodes tumours at a single institution. Descriptive analyses were conducted on demographic, disease and treatment (breast-conserving surgery, mastectomy, surgical re-excision, adjuvant/palliative radiation, palliative chemotherapy) information. Overall and disease-free survivals were analyzed, and the cumulative incidence of recurrence and metastases was compared.

Results

79 patients with phyllodes tumours of the breast were included in the study. Tumours were classified as malignant, borderline, or benign in 67.1%, 21.5%, and 11.4% of patients, respectively. There were no statistically significant differences in overall or disease-free survival between patients with benign, borderline or malignant disease. Only patients with malignant disease developed recurrence or metastases. Those with malignant disease who received mastectomies had a lower 10-year cumulative incidence of recurrence; however this was not statistically significant (p = 0.69). All patients had negative surgical margins due to a re-excision or mastectomy following margin-positive breast conserving surgery. Of all risk factors assessed, necrosis was significantly associated with increased incidence of recurrence (local or distant) in patients with malignant disease (p = 0.03).

Conclusion

The presence of tumour necrosis is a significant negative prognostic factor. Breast-conserving surgery may be adequate in providing local control, given negative surgical margins.

Introduction

Phyllodes tumours (PT) are histologically varied, and can range from resembling benign fibroadenomas to soft-tissue sarcomas [1]. Due to its diverse nature, this rare type of fibroepithelial lesion poses challenges in accurate prognostication and therapeutic management. Several pathological grading systems have been proposed to categorize these tumours. The system adopted by the World Health Organization classifies these tumours as benign, borderline, or malignant with consideration of tumour margins, stromal overgrowth, mitotic rate, cellular atypia, and necrosis [2]. The correlation between histological classification and subsequent biological behaviour of PTs continues to be debated. In their review, Tan et al. noted interpretive subjectivity in grading of these tumours [3].

The National Comprehensive Cancer Network (NCCN) recommends wide excision with margins of at least 1 cm [4]. In the absence of evidence from prospective or randomized studies, routine use of adjuvant radiation is not recommended. The objective of this retrospective review was to investigate clinical practices in the management of PT and patient outcomes at our centre.

Section snippets

Methods

A retrospective review was conducted on all patients diagnosed with PT who received treatment at Sunnybrook Odette Cancer Centre. Approval from the institutional research ethics board was obtained prior to initiation of the study. Patients were grouped according to diagnosis (benign, borderline, and malignant). Descriptive analyses were conducted on patient demographics, pathological features, and treatment characteristics. Continuous variables were summarized as mean, standard deviation (SD)

Results

A total of 79 patients diagnosed with PTs of the breast were treated at the Sunnybrook Odette Cancer Centre from 1999 to 2017. Tumors were classified as malignant in 53 patients (67.1%), borderline in 17 patients (21.5%) and benign in 9 patients (11.4%) (Table 1). The average age of patients was 48.9 years. Ten patients (12.7%) reported a prior diagnosis of PT, and 12 (15.2%) indicated previous benign breast tumours (e.g. fibroadenoma). Patients with benign tumours were followed for a median of

Discussion

Compared to previous reviews, adjuvant radiation was used in a larger proportion of patients with malignant disease (55%) due to close surgical margins (≤1 mm) or large tumour size (≥3 cm). Patients with malignant PT who received adjuvant radiation in this cohort displayed similar 10-year cumulative incidence of LR as patients who did not (9.9% vs. 9.1%). However, 10-year cumulative incidence of DR was higher, at 23.0% compared to 9.1% in patients who did not receive radiation.

In their analysis

Conclusion

Results from the present study are consistent with those previously reported. The presence of tumour necrosis is a significant negative prognostic factor of tumour-related events. Breast conserving surgery may be adequate in providing local control, given negative surgical margins. More investigation is needed to elucidate the impact of adjuvant radiation on local control and survival in this patient population.

Acknowledgements

We thank the generous support of Bratty Family Fund, Michael and Karyn Goldstein Cancer Research Fund, Joey and Mary Furfari Cancer Research Fund, Pulenzas Cancer Research Fund, Joseph and Silvana Melara Cancer Research Fund, and Ofelia Cancer Research Fund.

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