Anand Atul, Jha Chandan Kumar, Sinha Upasna, Gopinath Greeshma, Bhatt Deepti, Bhadani Punam Prasad, Singh Prashant Kumar
Department of General Surgery, All India Institute of Medical Sciences, Patna, Bihar 801507 India.
Department of General Surgery (Endocrine Surgery), All India Institute of Medical Sciences, Phulwarisharif, Patna, Bihar 801507 India.
Indian J Surg Oncol. 2024 Sep;15(3):463-468. doi: 10.1007/s13193-024-01926-w. Epub 2024 Mar 19.
Phyllodes tumors (PTs) are rare neoplasms of the breast that are a challenge in clinical practice. Though mostly benign, they are notorious for local recurrence, requiring adjuvant treatments. This study was planned to report the clinicopathological features and outcomes of patients with PT treated at our center. Details of all patients who underwent surgery for PT in the last 6 years (December 2017-December 2023) were obtained from our prospectively maintained database. The demographic, clinical, radiological, pathological, and follow-up details were recorded and analyzed. Statistical analyses were carried out with version 2.3.18. Out of 61 suspected PTs by triple assessment, 9 were excluded due to a non-phyllodes diagnosis on histopathology. We included 52 women with a mean age of 38.2 ± 11.0 years, most of whom were premenopausal (57.7%). BI-RADS 4 was the most common finding on radiological assessment (65.4%). Core needle biopsy (CNB) was the most frequently employed modality for histological diagnosis preoperatively (65.4% of cases). Wide local excisions (WLE) and mastectomies were done in 63.5% and 36.5% of patients, respectively. Benign, borderline, and malignant phyllodes constituted 67.3%, 15.4%, and 17.3% of tumors, respectively. Patients undergoing breast conservation surgery (BCS) had a significantly smaller mean tumor diameter than those who underwent a mastectomy ( < 0.001). Overall, the margin positivity rate was 34.6%. Patients undergoing mastectomy developed more local recurrence compared to WLE, although the difference was not significant ( = 0.400). The outcome following surgical excisions of large PTs in terms of margin positivity and local recurrence is the same, irrespective of whether BCS or mastectomy is done. A negative pathological margin width of > 1 mm appears acceptable. Malignant phyllodes with positive margins are associated with a higher rate of recurrence but positive margins in patients with other subtypes may not translate into recurrence, at least in the short term.
叶状肿瘤（PTs）是一种罕见的乳腺肿瘤，在临床实践中具有挑战性。尽管大多数为良性，但它们因局部复发而声名狼藉，需要辅助治疗。本研究旨在报告在我们中心接受治疗的PT患者的临床病理特征和预后情况。从我们前瞻性维护的数据库中获取了过去6年（2017年12月至2023年12月）所有接受PT手术患者的详细信息。记录并分析了人口统计学、临床、放射学、病理学及随访细节。使用2.3.18版本进行统计分析。在通过三重评估怀疑为PT的61例患者中，9例因组织病理学诊断非叶状肿瘤而被排除。我们纳入了52名女性，平均年龄为38.2±11.0岁，其中大多数为绝经前女性（57.7%）。放射学评估中最常见的结果是BI-RADS 4级（65.4%）。术前组织学诊断最常用的方法是粗针穿刺活检（CNB）（65.4%的病例）。分别有63.5%和36.5%的患者接受了广泛局部切除（WLE）和乳房切除术。良性、交界性和恶性叶状肿瘤分别占肿瘤的67.3%、15.4%和17.3%。接受保乳手术（BCS）的患者平均肿瘤直径明显小于接受乳房切除术的患者（<0.001）。总体而言，切缘阳性率为34.6%。与WLE相比，接受乳房切除术的患者局部复发更多，尽管差异不显著（=0.400）。无论进行BCS还是乳房切除术，大PT手术切除后的切缘阳性和局部复发情况相同。病理切缘宽度>1mm的阴性结果似乎是可以接受的。切缘阳性的恶性叶状肿瘤复发率较高，但其他亚型患者的切缘阳性至少在短期内可能不会导致复发。
