Phyllodes tumours (PT), comprising <1% of breast tumours, are rare fibroepithelial lesions ranging from benign to malignant. Although their excision is generally recommended, there is still no consensus on optimal PT management. This study thus aimed to better delineate the course and management of PT through our 15-year experience at a breast surgery unit.
This was a retrospective single-center study of patients with histologically proven PT from 2005-2021. Data regarding demographics, presentation, investigations, management, and follow-up were extracted, and were statistically analysed using R.
101 cases were identified, comprising 79 benign, 15 borderline and 7 malignant PT. Mean age was 39.7±17.0 years, and patients with malignant PT were significantly older (p=0.039). All patients presented with masses, 52.5% affecting the left breast. On triple assessment, higher clinical scores (p=0.008) and biopsy scores (p<0.001) were associated with malignancy, however ultrasound and mammogram scores were not. Biopsy histology was available for 98.9% of patients, of which 35.6% did not suspect PT on initial biopsy as they were predominantly believed to be fibroadenomas (84.4%). 93.1% underwent wide local excision (WLE), and 6.9% underwent mastectomies. The nearest excision margin was stated in 37.2% after WLE; however, only 5.7% were above the recommended 1cm, and 40.4% had positive margins. Mean margins were highest in malignant PT (p=0.054). Subsequently, 43.6% underwent margin excision, and 2 patients with malignant PT underwent mastectomy. Mean follow-up period was 29.4±35.2 months, with significantly longer FU in malignant PT (p<0.001). Recurrence rate was 12.9% overall, comprising 12 benign PT cases recurring as 8 benign, 2 borderline and 2 malignant PT, as well as 1 borderline PT recurrence. Survival was 92.4%, with no record of metastases.
Although rare and variable in disease course, comprehensive guidelines are needed in managing PT. In particular, further research is warranted into optimal excision margins and follow-up given the difficulty differentiating between benign fibroadenoma and early PT, and the risk of upgrading PT on recurrence.
The authors.
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All authors have declared no conflicts of interest.