Bogach Jessica, Shakeel Saad, Wright Frances C, Hong Nicole J Look
Department of Surgery, McMaster University, Hamilton, ON, Canada.
Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Ann Surg Oncol. 2022 Jan;29(1):446-459. doi: 10.1245/s10434-021-10468-2. Epub 2021 Jul 22.
Phyllodes tumors are rare tumors of the breast, with most literature being retrospective with limited guidelines on the management of these patients. Scoping review was performed to highlight themes and gaps in the available literature.
A scoping review of the literature was performed as per PRISMA-ScR guidelines with titles, abstracts, and full texts reviewed in duplicate. Data were abstracted and summarized in categories of diagnostics, surgical management, adjuvant therapies, treatment of recurrence, and surveillance. Quality assessment was performed for each paper.
The search identified 4498 references, 434 full-text papers were reviewed, and 183 papers were included. Ultrasound, magnetic resonance imaging, and core needle biopsy are valuable preoperative diagnostics tools. Pathology reporting should include stromal overgrowth, stromal cellularity, nuclear atypia, mitotic rate, borders, and presence of heterologous elements. Ki67 may have a role in grading and prognosticating. Breast conservation is safe in all grades of phyllodes but may be associated with increased local recurrence in malignant phyllodes. Surgical margins should depend on grade. Axillary node positivity rate is very low, even with clinically enlarged lymph nodes. Adjuvant radiation is a useful tool to decrease local recurrence in malignant phyllodes tumors, tumors > 5 cm, age < 45 years, close margins, and breast conservation. There is no evidence supporting adjuvant chemotherapy. Recurrence can be managed with repeat wide excision; however, mastectomy is associated with lower re-recurrence. Surveillance protocols are variable in the literature.
There is heterogeneity in the literature on phyllodes tumors. Consensus guidelines based on the literature will help provide evidence-based care.
叶状肿瘤是一种罕见的乳腺肿瘤，大多数文献为回顾性研究，针对这些患者的管理指南有限。进行范围综述以突出现有文献中的主题和差距。
按照PRISMA-ScR指南对文献进行范围综述，对标题、摘要和全文进行双人重复审查。数据按诊断、手术管理、辅助治疗、复发治疗和监测等类别进行提取和总结。对每篇论文进行质量评估。
检索到4498篇参考文献，审查了434篇全文论文，纳入183篇论文。超声、磁共振成像和粗针活检是有价值的术前诊断工具。病理报告应包括间质过度生长、间质细胞密度、核异型性、有丝分裂率、边界和异源性成分的存在。Ki67可能在分级和预后评估中发挥作用。保乳手术对所有级别的叶状肿瘤都是安全的，但在恶性叶状肿瘤中可能与局部复发增加有关。手术切缘应取决于肿瘤分级。腋窝淋巴结阳性率非常低，即使临床检查发现淋巴结肿大。辅助放疗是降低恶性叶状肿瘤、肿瘤>5 cm、年龄<45岁、切缘接近和保乳手术患者局部复发的有效手段。没有证据支持辅助化疗。复发可通过再次广泛切除进行处理；然而，乳房切除术与较低的再次复发率相关。文献中的监测方案各不相同。
关于叶状肿瘤的文献存在异质性。基于文献的共识指南将有助于提供循证护理。
