Amer Aimen, Ainley Paul, Thompson Ronald, Mathers Helen
The Breast Unit, Altnagelvin Area Hospital, Glenshane Road, Derry, Londonderry, BT47 6SB, UK.
Medical Biology Centre, Queens University Belfast, Lisburn Road, Belfast, BT9 7BL, UK.
Surgeon. 2018 Apr;16(2):74-81. doi: 10.1016/j.surge.2016.05.003. Epub 2016 Jun 28.
Resected phyllodes tumours (PT) of the breast carry a small but significant risk of recurrence. Nevertheless, there are no national guidelines on the postoperative follow-up of these tumours potentially resulting in a wide variation in practice among breast surgeons in the UK.
A web-based questionnaire was sent to breast surgeons across the UK to assess individual follow-up practices including availability of local guidelines, methods of follow-up and influence of risk factors.
Only 38% of 121 responses indicated the availability of local guidelines on PT follow-up. Modal follow-up duration for borderline and malignant disease was 5 years (53.7% and 79.3% of responses respectively), compared to 1 year for benign disease (43%) although 28% of respondents continue to review benign cases for 5 years. Immediate post-operative discharge and self-directed aftercare for benign and borderline cases remains uncommon practice in the UK. Within hospitals represented by more than one respondent in this survey, only around 30% demonstrated consistent practices pertaining to length and frequency of postoperative PT follow-up. Recurrent disease and margin status influenced the follow-up practice of 60% of respondents in our survey. More than 75% indicated that they combine clinical examination with radiological investigations (mammography and/or ultrasound) to follow up PT postoperatively.
This survey highlights the wide variation in follow-up practice for resected PT. This may affect the detection of disease relapse or, conversely, result in wasted clinical resources and unnecessary patient distress. Evidence-based national guidelines are necessary to resolve this issue and inform best follow-up practice.
切除的乳腺叶状肿瘤（PT）有较小但显著的复发风险。然而，目前尚无关于这些肿瘤术后随访的国家指南，这可能导致英国乳腺外科医生的实际操作存在很大差异。
向英国各地的乳腺外科医生发送了一份基于网络的问卷，以评估个人的随访做法，包括当地指南的可用性、随访方法和风险因素的影响。
121份回复中只有38%表明有关于PT随访的当地指南。交界性和恶性疾病的典型随访时长为5年（回复分别占53.7%和79.3%），而良性疾病为1年（43%），不过28%的受访者会对良性病例持续随访5年。在英国，良性和交界性病例术后立即出院并自行进行后续护理的做法并不常见。在本次调查中有多名受访者的医院中，只有约30%在PT术后随访的时长和频率方面做法一致。复发性疾病和切缘状态影响了本次调查中60%受访者的随访做法。超过75%的受访者表示他们会结合临床检查和影像学检查（乳房X线摄影和/或超声）对PT进行术后随访。
本次调查凸显了切除PT术后随访做法存在很大差异。这可能会影响疾病复发的检测，或者相反，导致临床资源浪费和患者不必要的痛苦。需要基于证据的国家指南来解决这一问题并指导最佳随访实践。
