Department of Histopathology, The University of Nottingham and the Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, UK.
Discipline of Pathology, NUI Galway, Lambe Institute for Translational Research, Galway, Ireland.
Histopathology. 2021 May;78(6):871-881. doi: 10.1111/his.14316. Epub 2021 Mar 22.
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.
叶状肿瘤（PTs）是一组罕见但复杂的乳腺病变，具有局部复发的倾向，且较少发生转移。在核心活检中，其表现可能难以与其他纤维上皮病变区分，这可能会影响其手术治疗。本研究旨在评估 PTs 的术前诊断，并评估手术管理和形态特征对其行为的影响。
我们将三个中心 20 多年的数据进行了合并，包括核心活检、切除标本和随访。将核心活检结果与最终的切除标本进行比较。评估了手术程序和形态特征与局部复发（LR）和转移的关系。研究了 241 例 PTs。核心活检结果诊断为可能或明确 PT 的占 76%。恶性肿瘤往往更大，发病年龄更大，手术更具挑战性，难以达到阴性切缘。有 12 例（5%）仅表现为 LR，另有 6 例（2.5%）出现远处转移。与不良预后相关的形态特征是 PT 的分级、有丝分裂计数增加、坏死、浸润性边缘、间质异型性和异源成分。LR 和转移行为均与肿瘤大小和距切缘的距离相关。
我们的结果表明，切除边缘对 PT 的 LR 有显著影响，而转移行为受肿瘤生物学的影响。我们增加了对肿瘤组织学特征的证据基础，这些特征有助于 PT 患者的长期预后。
