Department of Surgery, Division of Surgical Oncology, Loma Linda University School of Medicine, Loma Linda, CA, USA.
Department of Pathology, Loma Linda University School of Medicine, Loma Linda, CA, USA.
Ann Surg Oncol. 2018 Oct;25(10):3088-3095. doi: 10.1245/s10434-018-6622-3. Epub 2018 Jul 9.
In 2012, the World Health Organization (WHO) released diagnostic criteria for grading phyllodes tumors based on histologic features. This study sought to examine the application of the WHO criteria and the changing epidemiology of fibroepithelial tumors.
A retrospective review of surgically excised fibroepithelial lesions from 2007 to 2017 at a single tertiary care institution was conducted. Data regarding the WHO criteria (tumor border, stromal cellularity, stromal cell atypia, stromal overgrowth, mitotic activity) and traditional descriptors (leaf-like architecture, periductal stromal condensation) were collected. Clinical and pathologic characteristics of cases with diagnoses determined before and after 2012 were compared.
During the study period, 305 fibroepithelial tumors were identified. No significant differences were observed in terms of mean age, race/ethnicity, presenting symptoms, or method of diagnosis between cases diagnosed before and after 2012. After 2012, the findings showed statistically significant increases in reporting of WHO and traditional histologic features, a decrease in diagnoses of fibroadenomas (85.9% [116/135] before vs 70.0% [119/170] after 2012), and an increase in benign phyllodes tumors (0% [0/135] before vs 12.9% [22/170] after 2012). Patients with a diagnosis of benign phyllodes tumors were significantly younger than those with a diagnosis of borderline, malignant, or non-graded phyllodes tumors (mean age, 25.7 ± 10.6 vs 52.8 ± 9.9, 40.7 ± 24, 46.3 ± 1.5 years, respectively; p = 0.006).
The expanding use of the 2012 WHO criteria has been accompanied by an increased diagnostic frequency of benign phyllodes tumors and a decrease in fibroadenomas. As fibroepithelial diagnoses become more distinct, evidence-based management recommendations for less virulent phyllodes diagnoses should be developed.
2012 年，世界卫生组织（WHO）发布了基于组织学特征的叶状肿瘤分级诊断标准。本研究旨在检验 WHO 标准的应用和纤维上皮肿瘤的流行病学变化。
对 2007 年至 2017 年在一家三级医疗机构接受手术切除的纤维上皮病变进行回顾性研究。收集了关于 WHO 标准（肿瘤边界、间质细胞密度、间质细胞异型性、间质过度生长、有丝分裂活性）和传统描述符（叶状结构、导管周围间质浓缩）的数据。比较了 2012 年前和 2012 年后诊断的病例的临床和病理特征。
在研究期间，共发现 305 例纤维上皮肿瘤。2012 年前和 2012 年后诊断的病例在平均年龄、种族/民族、症状表现或诊断方法方面无显著差异。2012 年后，WHO 和传统组织学特征的报告显著增加，纤维腺瘤的诊断减少（85.9%[116/135] 2012 年前 vs 70.0%[119/170] 2012 年后），良性叶状肿瘤的诊断增加（0%[0/135] 2012 年前 vs 12.9%[22/170] 2012 年后）。良性叶状肿瘤患者的年龄明显小于交界性、恶性或未分级叶状肿瘤患者（平均年龄，25.7±10.6 岁 vs 52.8±9.9 岁、40.7±24 岁、46.3±1.5 岁；p=0.006）。
2012 年 WHO 标准的广泛应用伴随着良性叶状肿瘤诊断频率的增加和纤维腺瘤的减少。随着纤维上皮诊断变得更加明确，应制定出针对侵袭性较低的叶状肿瘤的循证管理建议。
