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e Geographic features of sample. (A) Regional distribution of respondents. (B) Response rates according to region. (C) Regional representation of NHS organisations. Actual response counts are displayed within bars.
Source publication
Background:
Resected phyllodes tumours (PT) of the breast carry a small but significant risk of recurrence. Nevertheless, there are no national guidelines on the postoperative follow-up of these tumours potentially resulting in a wide variation in practice among breast surgeons in the UK.
Methods:
A web-based questionnaire was sent to breast sur...
Context in source publication
Context 1
... three quarters of respondents were from NHS organisations in England although only half of NHS England organisations were represented in this survey, in contrast to Northern Ireland where all NHS organisations were represented. The regional distribution of respondents is demonstrated in Fig. 1AeC. Overall, 33.8% of respondents co-represented a hospital with at least one other respondent, and 50.4% corepresented a broader NHS ...
Citations
... For benign PT, there is no firm recommendation for clinical follow-up [13]. A survey conducted in the United Kingdom (UK) [14] and an international cross-sectional survey in sixteen countries across four continents [11] found a wide variation in follow-up practices for resected PT, and urged for evidence based national guidelines to inform best practice. A five-year follow-up period for all phyllodes tumours is preferred among surgeons and oncologists in an international cross-sectional survey [11]. ...
Background: Breast pathology reporting, especially for breast cancer, has evolved through the years, from terse succinct diagnostic conclusions with scant histological details to the current comprehensive reporting guidelines issued by major pathology colleges and bodies, including the International Collaboration on Cancer Reporting. Pathology elements included in reporting guidelines are evidence based and contribute significantly to individualised and personalised patient management. Summary: This article is based on the lively interactive question and answer session that followed the breast pathology segment in the symposium jointly organised by the British Association of Urological Pathology, British Association of Gynaecological Pathologists, British Society of Gastroenterology and the Association of Breast Pathology, in November 2022, titled ‘Personalised histopathology reporting for personalised medicine’. Key Messages: The breast pathology session emphasized the clinical utility of breast pathology data items, incorporating a case-based approach by highlighting the relevance of pathology information in various clinical scenarios. This review included clinico-pathological discussion points on florid lobular carcinoma in situ (LCIS), atypical apocrine adenosis, post-neoadjuvant chemotherapy reporting, atypical ductal hyperplasia (ADH) presenting at the margin, flat epithelial atypia (FEA) vs columnar cell change (CCC), papilloma on core needle biopsy (CNB), margin status, mucocele-like lesion, total duct excision/microdochectomy specimen, and anterior and nipple margins in skin-sparing mastectomy. Effective communication and regular involvement of pathologists in breast multidisciplinary tumour boards are crucial.
... Previous surveys of surgeons have noted the lack of specific guidelines to guide follow-up. 19 The paper discusses the frequency and duration of surveillance, as well as additional imaging studies that can be offered. All recommendations consider how WHO classification (benign, borderline, and malignant) impacts the risk of recurrence. ...
... The traditional surveillance of patients mainly depends on manual reminders of clinicians, which leads to inconsistent and potentially inadequate management of high-risk patients due to inconsistent physician practices based on different guidelines. 14,15 The combination of surveillance work with AI, which is good at handling mechanical and repetitive tasks, may address these surveillance-related issues. 16 In this study, we developed an automatic surveillance system combining deep learning and natural language ...
... As a result, the consistency between endoscopists is poor in the assignment of surveillance intervals. 14,15,22 ENDOANGEL-AS is based on recommendations for surveillance intervals given in the guidelines issued by ESGE and Chinese Medical Association. [5][6][7][8] As an auxiliary surveillance system, ENDOANGEL-AS could not initiatively determine the biopsy site, but only provides physicians with surveillance interval advice based on the maximum available information and clinical guidelines. ...
Background
Timely identification and regular surveillance of patients at high risk are crucial for early diagnosis of upper gastrointestinal cancer. However, traditional manual surveillance method is time-consuming, and current surveillance rate is below 50%. Here, we aimed to develop a surveillance system named ENDOANGEL-AS (automatic surveillance) for automatic identification and surveillance of high-risk patients.
Methods
7874 patients from Renmin Hospital of Wuhan University between May 1 and July 31, 2021 were used as the training set, 6762 patients between August 1 and October 31, 2021 as the internal test set, and 7570 patients from two other hospitals between August 1 and October 31, 2021 as the external test sets. We first extracted descriptions of abnormalities from endoscopic and pathological reports based on natural language processing techniques to identify individuals. Then patients were classified at nine risk levels according to endoscopic and pathological findings, and a deep learning model was trained to identify demarcation line (DL) in gastric low-grade intraepithelial neoplasia (LGIN) using 1561 white-light still images for risk stratification of gastric LGIN. Finally, patients undergoing upper endoscopy were classified and assigned one of ten surveillance intervals according to guidelines. The performance of ENDOANGEL-AS was evaluated and compared with physicians.
Findings
Patient identification module achieved an accuracy of 100% and 99.91% in internal and external test sets, respectively. Risk level classification module achieved an accuracy of 100% and 99.85% in the internal and external test sets, respectively. DL identification module achieved an accuracy of 87.88%. ENDOANGEL-AS on surveillance interval assignment achieved an accuracy of 99.23% and 99.67% in internal and external test sets, respectively. ENDOANGEL-AS had significantly higher accuracy compared with physicians (99.00% vs 38.87%, p < 0.001). The accuracy (63.67%, p < 0.001) of endoscopists with the assistance of ENDOANGEL-AS was significantly improved.
Interpretation
We established a surveillance system that can automatically identify patients and assign surveillance intervals with high accuracy and good transferability.
Funding
This work was partly supported by a grant from the Hubei Province Major Science and Technology Innovation Project (2018-916-000-008) and the Fundamental Research Funds for the Central Universities (2042021kf0084).
... El TP es un tumor fibroepitelial de mama compuesta de elementos estromales y epiteliales, correspondiendo al 2,5% de los tumores fibroepiteliales, pero compone el 1% de todas las neoplasias de mama (1,2). TP tiende a presentarse en principalmente mujeres, aunque se han descrito algunos casos en hombres, con incidencia máxima en mujeres de edad media (40-49 años), la población de tez blanca de Centroamérica y Suramérica son la etnia más frecuentemente afectada (1,3). ...
... El TP es un tumor fibroepitelial de mama compuesta de elementos estromales y epiteliales, correspondiendo al 2,5% de los tumores fibroepiteliales, pero compone el 1% de todas las neoplasias de mama (1,2). TP tiende a presentarse en principalmente mujeres, aunque se han descrito algunos casos en hombres, con incidencia máxima en mujeres de edad media (40-49 años), la población de tez blanca de Centroamérica y Suramérica son la etnia más frecuentemente afectada (1,3). ...
... Por lo general, los órganos afectados por metástasis a distancia son pulmón (70-80%), pleura (60-70%) y hueso (25-30%) (15,16). A todo paciente que presente TP maligno se recomienda realizar estudios de extensión para descartar proceso metastásico como manejo inicial y dar seguimiento de estos aproximadamente cada 3 meses (1,8) . ...
Los tumores phyllodes (TP) son neoplasias extremadamente infrecuentes que generalmente son benignas. Los pacientes con tumores phyllodes generalmente presentan una masa caracterizado por un rápido crecimiento en un corto período de tiempo. Nuestra paciente se auto palpo con una masa mama derecha con rápido crecimiento. Al biopsiar la masa es diagnosticado con tumor maligno phyllodes, se extirpa con márgenes adecuados, y luego se presentó con recidiva, operándola y volviendo hacer recidiva consecutivamente. Las biopsias comprobaron un tumor phyllodes maligno de alto grado, el cual se comportó muy agresivo. El objetivo de este informe de caso es aumentar la conciencia de estos tumores y sus presentaciones potencialmente inusuales para permitir a los médicos la capacidad de reconocer estas neoplasias antes y reconocer la necesidad de un abordaje.
... La recurrencia local ha sido descrita en casi todas las variantes histológicas y se han identificado diversos factores asociados con recurrencia tumoral y metástasis, dentro de los que se incluyen: margen tumoral, sobrecrecimiento estromal (principal factor pronóstico), número de mitosis y atipias celulares. Se ha visto que la recurrencia es mayor para los tumores malignos, en los cuales es cercana al 30%, mientras que para los benignos es de aproximadamente 15% [14,29]. ...
... y hueso (28-39%), aunque se han reportado casos de metástasis a hígado, cerebro, piel, cavidad nasal y oral, laringe, tiroides, pleura, entre otros. La mayoría de las pacientes en quienes se detectan metástasis mueren dentro de los primeros 3 años posterior al diagnóstico del tumor primario y una vez que se desarrollan metástasis, la sobrevida promedio es de 30 meses [6,14,29]. ...
... A pesar de que es esperable que el seguimiento esté relacionado con la naturaleza del tumor, se deben considerar también factores como la resección incompleta de los márgenes del tumor y la posibilidad de progresión de las recurrencias a un tipo biológico más agresivo. Por lo general, el seguimiento se realiza utilizando la valoración clínica junto con estudios radiológicos como ultrasonido y/o mamografía [29]. En la mayoría de los estudios consultados en esta revisión, el seguimiento se realiza basado en las pautas de seguimiento para sarcomas de tejidos blandos y en recomendaciones dadas por la NCCN (National Comprehensive Cancer Network). ...
Phyllodes tumor of the breast is a rare, but clinically important fibroepithelial tumor, accounting for <1% of breast tumors. Histologically, phyllodes tumor is classified into three; as: benign, borderline or malignant, based on a combination of histological and pathological criteria. This classification of the phyllodes breast tumor is precisely relevant in the clinic. While local recurrence of phyllodes tumor may occur in all grades, metastasis is mostly limited to malignant and few borderline cases, usually the latter two types having a worse prognosis of the disease. Treatment is mainly surgical as phyllodes tumor doesn´t respond well to systemic therapy. This review of the phyllodes tumor allows to guide the entire medical community based on the most recent evidence to diagnose and thus be able to manage this pathology, avoiding its complications.
... Inadequate surgical margin clearance contribute to these risks. 3,10,11 Patient's quality of life could be lowered because of the increase in the duration of follow up treatment and monitoring. ...
... These can occur in all type of classes and malignant type is at the highest risk. 3,10,11 The other factor contributing is due to the absence of preoperative diagnosis. 1 ...
Phyllodes tumor is a breast fibroepithelial lesion that rarely occurred. This type of tumor has tendency to recurre and metastasize. This study aimed to determine the features of phyllodes tumor in Hasan Sadikin General Hospital in period of 2012 to 2016, histopathologically and clinically. Descriptive study with cross sectional design was conducted in Department of Pathological Anatomy, Hasan Sadikin General Hospital, Bandung, from September 2016 to May 2017. Using total sampling, the secondary data are taken from medical records with the diagnosis of phyllodes tumor. From 88 samples taken, the mean age of the tumor occurrence is 45,56 years old and the mean size of tumor diameter is 10,98 cm. Tumor with benign type has the highest prevalence, with 54 cases reported. Mastectomy is the most common procedure performed on this tumor. There are 7 recurred patients and 1 patient with metastasis. As conclusions, phyllodes tumor is a rare tumor. In Hasan Sadikin general hospital, it mostly occurs in women aged 45 years old in the benign type. Mastectomy is often performed as a choice of surgical treatment.
... Although it is well known that the prognosis of metastatic disease from PTs and soft tissue sarcomas in general, to which treatment in systemic recurrence of PTs are patterned after 3 , is dismal, efforts other than development of better chemotherapeutic drugs like doxorubicin and ifosfamide 8 are still rightfully undertaken. As unusual features like hyperplasia, metaplasia, dysplasia, in-situ or even frank invasive malignancy have been shown to occur in some benign PTs 14 , clinico-pathologic factors other than histologic classification have been studied to better predict the likelihood of recurrence and metastasis and influence not only adjuvant treatment such as endocrine 15 , radiation 16 and chemo-therapy 17 which have largely been with no proven role or controversial 3 especially in benign PTs, but also impact postoperative surveillance or follow-up strategy 18 and formation of consensus guidelines. 19 In a review from the City of Hope Comprehensive Cancer Center in Los Angeles, CA, USA of 478 patients with PTs, post-operative adjuvant radiation therapy was recommended for malignant PTs >2cm treated by lumpectomy alone and tumors >10 cm treated by mastectomy alone as local recurrence was shown to adversely impact survival rates. ...
Objective: As there is a dearth of information on phyllodes tumors of the breast in the Philippines yet this ultimately impacts on the management and survival of Filipino patients, the authors reviewed their surgical cases of phyllodes tumors, focusing in this report, for the first time in Philippine literature, on the real risk of distant metastasis from the more common benign variety of phyllodes tumors. They therefore aim to identify case/s and do a review of literature on distant metastasis from benign phyllodes tumors. Methods: A review of records of all surgical cases of phyllodes tumor managed at PGH from 2005 – 2014 was done. Data from patients who on follow up were found to have distant metastasis were gathered and further reviewed. A literature search on metastatic phyllodes tumor and its implications was likewise done to complete this study. Results: A total of 200 patients with phyllodes tumor surgically managed within the study period were reviewed and followed up. One hundred sixty one out of 200 (80.5%) patients were histologically classified as benign. Twelve patients out of 200 (6.0%) developed distant metastasis on follow up, 1 (0.62% of 161 benign phyllodes tumors) of whom had benign phyllodes tumor. Conclusion: The authors show that distant metastasis from benign phyllodes tumor can occur here in the Philippines. Therefore, the subtype of phyllodes tumor alone, especially in benign lesions, does not absolutely predict biological behavior and risk of recurrence. A better understanding of the true nature of metastasis in these tumors is highly anticipated. Key words: Breast surgery, Phyllodes, metastasis, benign
Background:
Phyllodes tumors (PTs) are rare tumors of the breast. The current National Comprehensive Cancer Network (NCCN) guidelines recommend excision of benign PTs, accepting close or positive margins. Controversy about the optimal treatment for benign PTs remains, especially regarding the preferred margin width after surgical excision and the need for follow-up evaluation.
Methods:
A nationwide retrospective study analyzed the Dutch population from 1989 to 2022. All patients with a diagnosis of benign PT were identified through a search in the Dutch nationwide pathology databank (Palga). Information on age, year of diagnosis, size of the primary tumor, surgical treatment, surgical margin status, and local recurrence was collected.
Results:
The study enrolled 1908 patients with benign PT. The median age at diagnosis was 43 years (interquartile range [IQR], 34-52 years), and the median tumor size was 30 mm (IQR, 19-40 mm). Most of the patients (95%) were treated with breast-conserving surgery (BCS). The overall local recurrence rate was 6.2%, and the median time to local recurrence was 31 months (IQR, 15-61 months). Local recurrence was associated with bilaterality of the tumor (odds ratio [OR], 4.91; 95% confidence interval [CI], 2.95-28.30) and positive margin status (OR, 2.51; 95% CI 1.36-4.63). The local recurrence rate was 8.9% for the patients with positive excision margins and 4.0% for the patients with negative excision margins. Notably, for 27 patients (22.6%) who experienced a local recurrence, histologic upgrading of the recurrent tumor was reported, 7 (5.9%) of whom had recurrence as malignant lesions.
Conclusions:
This nationwide series of 1908 patients showed a low local recurrence rate of 6.2% for benign PT, with higher recurrence rates following positive margins.
Backgrounds:
Optimal and tailored surgical treatment of phyllodes tumour(PT) of the breast is controversial. This study aims to determine the appropriate surgical margin in the treatment of PT.
Methodology:
The data of 132 patients who underwent breast surgery with the diagnosis of PT at the Breast Unit of Istanbul Faculty of Medicine from 2000 to 2022 were retrospectively reviewed.
Results:
Median age was 38 and patients with benign PT were younger than others(median age was 34, 44, and 43 for benign, borderline, and malignant, respectively) (P = 0.001). Local recurrence was observed in 7 (5.3%) patients, systemic recurrence was observed in 3 (2.3%) patients, and disease-related death was observed in 2 (1.5%) patients. Local recurrence occurred in 1.4% (n = 1) of benign tumours, 8.3% (n = 2) of borderline tumours, and 10.3% (n = 4) of malignant tumours. All of the systemic recurrences and deaths were seen in the malignant group. The local recurrence rate was found to be higher in borderline and malignant tumours with surgical margins less than 10 mm (44.4% versus 3.7%, P = 0.003), and tumours larger than 5 cm (11.8% versus 1.3%, P = 0.015). In comparison, there was no correlation between the surgical margin proximity, tumour diameter, and local recurrence rates in benign PT (P > 0.05).
Conclusion:
According to our findings, negative surgical margins seem to be sufficient in the treatment of benign phyllodes tumours. Furthermore at least 1 cm negative surgical margins must be achieved for malignant and borderline phyllodes tumours to avoid local recurrence.
A Phyllodes Tumour (PT) is an uncommon fibroepithelial lesion, with three histological grades – benign, borderline and malignant. PTs cause significant challenges in diagnosis, management and prognostication. Recent publications have clarified the definitions and prognostication of PTs. Contemporary data currently challenge international guidelines on PT management. We performed an in-depth literature review to develop a best-practice management algorithm for PTs.
Diagnostic recommendations are that neither current imaging techniques, nor fine-needle biopsies, can reliably diagnose a PT. Core needle biopsy is the optimal diagnostic technique. Indeterminate or suspicious lesions are recommended to undergo an excisional biopsy due to the inherently heterogeneous nature of PTs.
Management guidelines are that benign PTs should be completely excised, although an involved margin is acceptable in select situations. Borderline PTs should have a clear margin on excision due to their higher risk of recurrence, as well as the potential for a recurrence to progress to a malignant PT. In malignant PTs, a margin of 3 mm is acceptable as there is no reduction in recurrence risk if margins are >3 mm. Routine axillary surgery is not indicated in PTs, with axillary surgery only indicated in a histologically-confirmed positive axilla.
Adjuvant treatment recommendations are that borderline and malignant PTs should be discussed at MDT, with radiotherapy considered in both. Chemotherapy should be discussed in malignant PT patients.
In summary, we have developed an up-to-date simple algorithm to guide the surgeon's management of patients diagnosed with PTs and reduce excessive surgery.
