Clinicopathologic features and long-term outcomes of 293 phyllodes tumors of the breast Journal Article

Authors: Barrio, A. V.; Clark, B. D.; Goldberg, J. I.; Hoque, L. W.; Bernik, S. F.; Flynn, L. W.; Susnik, B.; Giri, D.; Polo, K.; Patil, S.; Van Zee, K. J.
Article Title: Clinicopathologic features and long-term outcomes of 293 phyllodes tumors of the breast
Abstract: Background: Phyllodes tumors (PT) are rare fibroepithelial neoplasms of the breast with unpredictable behavior. We reviewed our single institution experience with PT over 51 years to identify factors predictive of local recurrence (LR) and metastasis. Methods: From 1954 to 2005, a total of 352 cases of PT were identified; 293 had follow-up. All available pathology slides (90%) were rereviewed for margins, borders, fibroproliferation in the surrounding breast tissue, stromal pattern, stromal cellularity, frequency of mitoses, and necrosis. Results: All cases occurred in women, with a median age of 42, with 203 originally categorized as benign and 90 as malignant. Median follow-up was 7.9 years. A total of 35 patients developed LR at a median of 2 years. In univariate analyses, a higher actuarial LR rate was associated with positive margins (P = .04), fibroproliferation (P = .001), and necrosis (P = .006). PT classified as malignant did not have a higher risk of LR (P = .79). Five patients developed distant disease at a median of 1.2 years. These patients constituted 71% of the seven patients who had uniformly aggressive pathologic features, including large tumor size (≥7.0 cm), infiltrative borders, marked stromal overgrowth, marked stromal cellularity, high mitotic count, and necrosis. Conclusions: Positive margins, fibroproliferation in the surrounding breast tissue, and necrosis are associated with a marked increase in LR rates. Efforts should be made to achieve negative surgical margins to reduce risk of LR. Death from PT is rare (2%), and only PT that demonstrate uniformly aggressive pathologic features seem to be associated with mortality. © 2007 Society of Surgical Oncology.
Keywords: survival; adolescent; adult; child; controlled study; aged; aged, 80 and over; middle aged; retrospective studies; major clinical study; clinical feature; follow up; follow-up studies; mitosis; cell death; cell division; neoplasm recurrence, local; diagnosis, differential; breast; phyllodes tumor; cystosarcoma phylloides; tumor volume; breast neoplasms; necrosis; risk; disease progression; neoplasm invasiveness; stroma cell; stromal cells; univariate analysis; local recurrence; long-term outcomes; clinicopathologic features; distant disease; actuarial analysis
Journal Title: Annals of Surgical Oncology
Volume: 14
Issue: 10
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2007-10-01
Start Page: 2961
End Page: 2970
Language: English
DOI: 10.1245/s10434-007-9439-z
PUBMED: 17562113
PROVIDER: scopus
Notes: --- - "Cited By (since 1996): 21" - "Export Date: 17 November 2011" - "CODEN: ASONF" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Sujata Patil
    386 Patil
  2. Andrea Veronica Barrio
    38 Barrio
  3. Laurie Wolford Flynn
    6 Flynn
  4. Kimberly J Van Zee
    242 Van Zee
  5. Dilip D Giri
    123 Giri
  6. Stephanie F Bernik
    6 Bernik
  7. Barbara Susnik
    8 Susnik
  8. Laura Weldon Hoque
    4 Hoque
  9. Bradly D Clark
    15 Clark
  10. Kristen L Polo
    3 Polo