Correlations of morphological features and surgical management with clinical outcome in a multicentre study of 241 phyllodes tumours of the breast.
morphology
outcome
phyllodes
resection margins
surgical management
Journal
Histopathology
ISSN: 1365-2559
Titre abrégé: Histopathology
Pays: England
ID NLM: 7704136
Informations de publication
Date de publication:
May 2021
May 2021
Historique:
received:
13
09
2020
accepted:
12
12
2020
pubmed:
17
12
2020
medline:
19
11
2021
entrez:
16
12
2020
Statut:
ppublish
Résumé
Phyllodes tumours (PTs) represent an unusual but complex group of breast lesions with a tendency to recur locally and, less commonly, metastasise. On core biopsies, their appearances can be difficult to discriminate from those of other fibroepithelial lesions, which may compromise their surgical management. The aims of this study were to assess the preoperative diagnosis of PTs and to evaluate the impacts of surgical management and morphological features on their behaviour. We combined datasets from three centres over two decades, including core biopsies, excision specimens, and follow-up. Core biopsy results were compared with final excision specimens. The relationships of surgical procedure and morphological features with local recurrence (LR) and metastasis were assessed. Two hundred and forty-one PTs were studied. Core biopsy resulted in a diagnosis of possible or definite PT in 76% of cases. Malignant tumours were more likely to be larger, occurred at an older age, and were surgically more challenging, with difficulties being encountered in achieving negative margins. There were 12 cases (5%) that showed LR alone, and another six cases (2.5%) that had distant metastases. Morphological features associated with adverse outcome were grade of PT, increased mitotic counts, necrosis, infiltrative margins, stromal atypia, and heterologous components. Both LR and metastatic behaviour correlated with larger size and distance to margins. Our results suggest that excision margins have a significant impact on LR of PT, whereas metastatic behaviour is influenced by tumour biology. We add to the evidence base on histological features of tumours that contribute to long-term outcomes of PT patients.
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
871-881Informations de copyright
© 2021 John Wiley & Sons Ltd.
Références
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.
Karim RZ, Scolyer RA, Tse GM, Tan PH, Putti TC, Lee CS. Pathogenic mechanisms in the initiation and progression of mammary phyllodes tumours. Pathology 2009; 41; 105-117.
Jara-Lazaro AR, Tan PH. Molecular pathogenesis of progression and recurrence in breast phyllodes tumors. Am. J. Transl. Res. 2009; 1; 23-34.
WHO Classification of Tumours Editorial Board eds. World Health Organization classification of tumours, 5th edn, Vol. 2: Breast tumours. Lyon: IARC Press, 2019.
Lawton TJ, Acs G, Argani P et al. Interobserver variability by pathologists in the distinction between cellular fibroadenomas and phyllodes tumors. Int. J. Surg. Pathol. 2014; 22; 695-698.
Krishnamurthy S, Ashfaq R, Shin HJ, Sneige N. Distinction of phyllodes tumor from fibroadenoma: a reappraisal of an old problem. Cancer 2000; 90; 342-349.
Fajdic J, Gotovac N, Hrgovic Z, Kristek J, Horvat V, Kaufmann M. Phyllodes tumors of the breast - diagnostic and therapeutic dilemmas. Onkologie 2007; 30; 113-118.
Reinfuss M, Mitus J, Duda K, Stelmach A, Rys J, Smolak K. The treatment and prognosis of patients with phyllodes tumor of the breast: an analysis of 170 cases. Cancer 1996; 77; 910-916.
Barth RJ Jr. Histologic features predict local recurrence after breast conserving therapy of phyllodes tumors. Breast Cancer Res. Treat. 1999; 57; 291-295.
Mangi AA, Smith BL, Gadd MA, Tanabe KK, Ott MJ, Souba WW. Surgical management of phyllodes tumors. Arch. Surg. 1999; 134; 487-492; discussion 492-493.
Chaney AW, Pollack A, McNeese MD et al. Primary treatment of cystosarcoma phyllodes of the breast. Cancer 2000; 89; 1502-1511.
Cheng SP, Chang YC, Liu TP, Lee JJ, Tzen CY, Liu CL. Phyllodes tumor of the breast: the challenge persists. World J. Surg. 2006; 30; 1414-1421.
Jang JH, Choi MY, Lee SK et al. Clinicopathologic risk factors for the local recurrence of phyllodes tumors of the breast. Ann. Surg. Oncol. 2012; 19; 2612-2617.
Lin CC, Chang HW, Lin CY, Chiu CF, Yeh SP. The clinical features and prognosis of phyllodes tumors: a single institution experience in Taiwan. Int. J. Clin. Oncol. 2013; 18; 614-620.
Mitus J, Reinfuss M, Mitus JW et al. Malignant phyllodes tumor of the breast: treatment and prognosis. Breast J. 2014; 20; 639-644.
Onkendi EO, Jimenez RE, Spears GM, Harmsen WS, Ballman KV, Hieken TJ. Surgical treatment of borderline and malignant phyllodes tumors: the effect of the extent of resection and tumor characteristics on patient outcome. Ann. Surg. Oncol. 2014; 21; 3304-3309.
Yom CK, Han W, Kim SW, Park SY, Park IA, Noh DY. Reappraisal of conventional risk stratification for local recurrence based on clinical outcomes in 285 resected phyllodes tumors of the breast. Ann. Surg. Oncol. 2015; 22; 2912-2918.
Tan BY, Acs G, Apple SK et al. Phyllodes tumours of the breast: a consensus review. Histopathology 2016; 68; 5-21.
Zhou ZR, Wang CC, Sun XJ, Yang ZZ, Yu XL, Guo XM. Diagnostic performance of core needle biopsy in identifying breast phyllodes tumors. J. Thorac. Dis. 2016; 8; 3139-3151.
Pinder SE, Shaaban A, Deb R et al. NHS Breast Screening multidisciplinary working group guidelines for the diagnosis and management of breast lesions of uncertain malignant potential on core biopsy (B3 lesions). Clin. Radiol. 2018; 73; 682-692.
Zhang Y, Kleer CG. Phyllodes tumor of the breast: histopathologic features, differential diagnosis, and molecular/genetic updates. Arch. Pathol. Lab. Med. 2016; 140; 665-671.
Barrio AV, Clark BD, Goldberg JI et al. Clinicopathologic features and long-term outcomes of 293 phyllodes tumors of the breast. Ann. Surg. Oncol. 2007; 14; 2961-2970.
Badwe RA, Kataria K, Srivastava A. Surgical resection of phyllodes tumour: a radical approach as a safeguard against local recurrence. Indian J. Surg. 2015; 77; 161-163.
Abdalla HM, Sakr MA. Predictive factors of local recurrence and survival following primary surgical treatment of phyllodes tumors of the breast. J. Egypt. Natl Canc. Inst. 2006; 18; 125-133.
Taira N, Takabatake D, Aogi K et al. Phyllodes tumor of the breast: stromal overgrowth and histological classification are useful prognosis-predictive factors for local recurrence in patients with a positive surgical margin. Jpn. J. Clin. Oncol. 2007; 37; 730-736.
Sotheran W, Domjan J, Jeffrey M, Wise MH, Perry PM. Phyllodes tumours of the breast - a retrospective study from 1982-2000 of 50 cases in Portsmouth. Ann. R. Coll. Surg. Engl. 2005; 87; 339-344.
Ogunbiyi S, Perry A, Jakate K, Simpson J, George R. Phyllodes tumour of the breast and margins: how much is enough. Can. J. Surg. 2019; 62; E19-E21.
Parker SJ, Harries SA. Phyllodes tumours. Postgrad. Med. J. 2001; 77; 428-435.
Eroglu E, Irkkan C, Ozsoy M, Eroglu F. Phyllodes tumor of the breast: case series of 40 patients. Eur. J. Gynaecol. Oncol. 2004; 25; 123-125.
Bennett IC, Khan A, De Freitas R, Chaudary MA, Millis RR. Phyllodes tumours: a clinicopathological review of 30 cases. Aust. N. Z. J. Surg. 1992; 62; 628-633.
Tan PH. Fibroepithelial lesions revisited: implications for diagnosis and management. Mod. Pathol. 2020. 34(Suppl 1);15-37.
Dillon MF, Quinn CM, McDermott EW, O'Doherty A, O'Higgins N, Hill AD. Needle core biopsy in the diagnosis of phyllodes neoplasm. Surgery 2006; 140; 779-784.
Komenaka IK, El-Tamer M, Pile-Spellman E, Hibshoosh H. Core needle biopsy as a diagnostic tool to differentiate phyllodes tumor from fibroadenoma. Arch. Surg. 2003; 138; 987-990.
Slodkowska E, Nofech-Mozes S, Xu B et al. Fibroepithelial lesions of the breast: a comprehensive morphological and outcome analysis of a large series. Mod. Pathol. 2018; 31; 1073-1084.
Yan Z, Gudi M, Saffari SE et al. Preoperative radiological and histological features predict phyllodes tumor grade. Breast J. 2020; 26; 2122-2124.
Ciatto S, Bonardi R, Cataliotti L, Cardona G. Phyllodes tumor of the breast: a multicenter series of 59 cases. Coordinating Center and Writing Committee of FONCAM (National Task Force for Breast Cancer), Italy. Eur. J. Surg. Oncol. 1992; 18; 545-549.
Macdonald OK, Lee CM, Tward JD, Chappel CD, Gaffney DK. Malignant phyllodes tumor of the female breast: association of primary therapy with cause-specific survival from the Surveillance, Epidemiology, and End Results (SEER) program. Cancer 2006; 107; 2127-2133.
Choi N, Kim K, Shin KH et al. Malignant and borderline phyllodes tumors of the breast: a multicenter study of 362 patients (KROG 16-08). Breast Cancer Res. Treat. 2018; 171; 335-344.
Koh VCY, Thike AA, Nasir NDM, Yip GWC, Bay BH, Tan PH. Size and heterologous elements predict metastases in malignant phyllodes tumours of the breast. Virchows Arch. 2018; 472; 615-621.
Di Liso E, Bottosso M, Lo Mele M et al. Prognostic factors in phyllodes tumours of the breast: retrospective study on 166 consecutive cases. ESMO Open 2020; 5; e000843.
Kapiris I, Nasiri N, A'Hern R, Healy V, Gui GP. Outcome and predictive factors of local recurrence and distant metastases following primary surgical treatment of high-grade malignant phyllodes tumours of the breast. Eur. J. Surg. Oncol. 2001; 27; 723-730.