The Royal Marsden NHS Foundation Trust, London, UK.
The Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK.
Clin Oncol (R Coll Radiol). 2024 Jan;36(1):e31-e39. doi: 10.1016/j.clon.2023.10.050. Epub 2023 Oct 21.
Phyllodes tumours and breast sarcomas are uncommon tumours and their rarity poses significant challenges in diagnosis and management. This cross-sectional study was conducted to evaluate the multidisciplinary clinical practice for these tumours across the UK and Ireland, with the aim of identifying gaps in knowledge and providing direction for establishing national guidelines.
An international survey was adapted and circulated to breast and/or sarcoma surgeons and oncologists in the UK and Ireland through national organisations. Multidisciplinary team (MDT) responses were analysed anonymously.
Twenty-eight MDTs participated in this study, predominately from high-volume units (85.5%). Although only 43% of the surveyed units were part of a trust that holds a sarcoma MDT, 68% of units managed malignant phyllodes and angiosarcoma, whereas 64.5% managed soft-tissue sarcoma of the breast. Across all subtypes, axillary surgery was recommended by 14-21% of the MDTs and the most recommended resection margins for breast surgery were 'no tumour on ink' in benign phyllodes (39%) and 10 mm in the remaining subtypes (25-29%). Immediate breast reconstruction was supported by 11-18% of MDTs for breast sarcoma subtypes, whereas 36% and 32% advocated this approach in benign and borderline phyllodes tumours, respectively. Adjuvant radiotherapy and chemotherapy were recommended by up to 29% and 11% of the MDTs, respectively.
The results of this study demonstrate a wide variation in clinical practice across the surveyed MDTs. As only 28 MDTs participated in our study, with under-representation from low-volume units, our results might be an underestimation of the variability in practice across the UK and Ireland. This multi-institutional study sheds light on controversial aspects in the management of phyllodes tumours and breast sarcoma, identifies the need for national guidelines to inform best practice, and calls for the centralisation of the management of breast sarcoma within specialist centres.
叶状肿瘤和乳腺肉瘤是罕见的肿瘤，其罕见性给诊断和治疗带来了重大挑战。本横断面研究旨在评估英国和爱尔兰的多学科临床实践，以评估这些肿瘤的知识差距，并为制定国家指南提供方向。
通过国家组织，将国际调查改编并分发给英国和爱尔兰的乳腺和/或肉瘤外科医生和肿瘤学家。对多学科团队（MDT）的回应进行了匿名分析。
共有 28 个 MDT 参与了这项研究，主要来自大容量单位（85.5%）。尽管只有 43%的调查单位属于拥有肉瘤 MDT 的信托基金，但 68%的单位管理恶性叶状肿瘤和血管肉瘤，而 64.5%的单位管理乳腺软组织肉瘤。在所有亚型中，14-21%的 MDT 建议进行腋窝手术，乳腺手术最推荐的切除边缘是良性叶状肿瘤的“无肿瘤墨迹”（39%）和其余亚型的 10 毫米（25-29%）。11-18%的 MDT 支持乳腺肉瘤亚型的即刻乳房重建，而 36%和 32%分别在良性和交界性叶状肿瘤中提倡这种方法。高达 29%和 11%的 MDT 建议辅助放疗和化疗。
本研究结果表明，调查 MDT 之间的临床实践存在广泛差异。由于只有 28 个 MDT 参与了我们的研究，低容量单位的代表性不足，因此我们的研究结果可能低估了英国和爱尔兰实践的多样性。这项多机构研究揭示了叶状肿瘤和乳腺肉瘤管理中的一些有争议的方面，确定了制定国家指南以告知最佳实践的必要性，并呼吁将乳腺肉瘤的管理集中在专门中心。
