Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Ann Surg Oncol. 2022 Oct;29(10):6151-6161. doi: 10.1245/s10434-022-12192-x. Epub 2022 Jul 18.
Phyllodes tumors (PTs) are rare breast neoplasms with variable clinical behavior by histologic type: benign, borderline, or malignant. Until recently, management guidelines recommended one approach for all subtypes.
A 21-question survey was sent to American Society of Breast Surgeon members to evaluate management patterns by subtype. Surgeon demographics, decisions regarding management of margins, re-excision, surveillance, and synoptic reporting were collected. Chi-square or analysis of variance (ANOVA) were used as appropriate, with significance set at p < 0.05.
A total of 493 of 2969 surveys were completed for a response rate of 18.3%. Among the survey takers, 55% were fellowship trained, 72% were in practice > 10 years, and 82% performed > 100 breast cases per year. Although 25% of respondents enucleate a mass with clinical suspicion of a PT alone, this decreased to 18% if a preoperative core biopsy performed was suggestive of PT. For margin management, 47% do not re-excise positive margins for benign PTs, but 96% would for a borderline or malignant PTs (p < 0.001). Only 2% perform axillary staging for malignant PTs, and 90% refer borderline or malignant PTs for radiation. Two-year surveillance was performed by about half of respondents for benign PT. However, two-thirds of respondents would increase surveillance to 5 years for borderline or malignant PTs. Only 38% report a templated synoptic pathology report at their institution.
PT management patterns are evolving but still variable when looking at initial margin intent, decision for re-excision, radiation referral, pathologic reporting, and surveillance. This suggests the need for more specific management guidelines by subtype given differences in clinical behavior.
叶状肿瘤（PTs）是一种罕见的乳腺肿瘤，其临床行为因组织学类型而异：良性、交界性或恶性。直到最近，管理指南还建议对所有亚型采用一种方法。
向美国乳腺外科医师协会成员发送了一份 21 个问题的调查问卷，以评估各亚型的管理模式。收集了外科医生的人口统计学资料、关于边缘管理、再次切除、监测和综合报告的决策。适当使用卡方检验或方差分析（ANOVA），以 p<0.05 为显著性标准。
在 2969 份调查中，共有 493 份完成，应答率为 18.3%。在调查参与者中，55%接受过奖学金培训，72%从业时间>10 年，82%每年进行>100 例乳腺手术。尽管 25%的受访者仅在临床怀疑为 PT 时进行肿块切除术，但如果术前核心活检提示为 PT，则这一比例降至 18%。对于边缘管理，47%的良性 PT 不切除阳性边缘，但 96%的交界性或恶性 PT 会切除（p<0.001）。只有 2%的人对恶性 PT 进行腋窝分期，90%的人将交界性或恶性 PT 转介进行放疗。约一半的受访者对良性 PT 进行 2 年的监测。然而，三分之二的受访者会将交界性或恶性 PT 的监测延长至 5 年。只有 38%的人在其机构报告模板化的综合病理报告。
PT 的管理模式正在演变，但在初始边缘意图、再次切除的决定、放疗转介、病理报告和监测方面仍然存在差异。这表明，鉴于临床行为的差异，需要针对不同亚型制定更具体的管理指南。
