The North of England Bone and Soft Tissue Tumour Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
The North of England Bone and Soft Tissue Tumour Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
Eur J Surg Oncol. 2024 Sep;50(9):108534. doi: 10.1016/j.ejso.2024.108534. Epub 2024 Jul 6.
Phyllodes tumours of the breast are rare, and their treatment is still subject to discussion. They are classified as benign, borderline, or malignant based on histopathological characteristics of the stroma. This study demonstrates 10 years' experience in diagnosis and management of malignant phyllodes.
All patients referred for discussion at our sarcoma multidisciplinary team meeting from 2003 to 2013 with a diagnosis of malignant phyllodes were identified. Patient demographics, biopsy details, excision extent, final pathology, reconstruction, adjuvant treatment, recurrence and overall survival were assessed.
Thirty patients were identified over the 10 year period. Eight (26.7 %) had their diagnosis upgraded to malignant phyllodes on completion excision, compared to initial biopsy. Nine (30 %) had breast surgery elsewhere as definitive treatment before referral to our service. Four of these (44.4 %) required more extensive excision and three developed metastases (33.3 %) and died. Twenty-one patients had primary surgery through our service and three (14.3 %) died from disease. Overall, 13 patients had radical mastectomy, 92.3 % with adequate margins (>1 cm histologically) and no local recurrence, 9 simple mastectomy 22.2 % with adequate margins and 1 local recurrence and 8 wide local excision with 37.5 % adequate margins and 1 local recurrence.
For malignant phyllodes patients, the best chance to reduce recurrence and improve survival is adequate excision and radical mastectomy should be considered. For borderline lesions, consideration should be given for referral to a specialist centre and we recommend delayed reconstruction, because of the chance of histological upgrade to malignancy.
乳腺叶状肿瘤罕见，其治疗方法仍存在争议。根据肿瘤间质的组织病理学特征，将其分为良性、交界性或恶性。本研究展示了 10 年来诊断和治疗恶性叶状肿瘤的经验。
从 2003 年至 2013 年，通过肉瘤多学科团队会议讨论，确定了所有诊断为恶性叶状肿瘤的患者。评估患者的人口统计学资料、活检细节、切除范围、最终病理、重建、辅助治疗、复发和总生存情况。
在 10 年期间共发现 30 例患者。与初始活检相比，在完成切除后，有 8 例（26.7%）诊断升级为恶性叶状肿瘤。9 例（30%）在转诊至我们的服务机构之前，已在其他地方进行了乳腺手术作为确定性治疗。其中 4 例（44.4%）需要更广泛的切除，3 例发生转移（33.3%）并死亡。21 例患者在我们的服务机构进行了初次手术，其中 3 例（14.3%）死于疾病。总体而言，13 例患者接受了根治性乳房切除术，92.3%的患者切缘足够（>1cm 组织学），无局部复发，9 例接受了单纯乳房切除术，22.2%的患者切缘足够，1 例局部复发，8 例接受了广泛局部切除术，37.5%的患者切缘足够，1 例局部复发。
对于恶性叶状肿瘤患者，减少复发和提高生存率的最佳机会是充分切除，应考虑根治性乳房切除术。对于交界性病变，应考虑转诊至专业中心，并建议延迟重建，因为有组织学升级为恶性的机会。
