Is Benign Phyllodes Truly Benign?
Association of Breast Surgery ePoster Library. Sharma A. 05/15/17; 166318; P103
Anita Sharma
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Abstract
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Introduction
Phyllodes tumours of the breast are uncommon fibroepithelial neoplasms usually managed with surgical excision. They are classified as benign, borderline or malignant but all carry a risk of local recurrence. The value of clinical follow-up for excised benign and borderline lesions remains unclear. This study assesses ten years of experience in our unit.
Methods
Retrospective analysis using the pathology SNOMED database identified 126 Phyllodes lesions. Clinical data on those with benign and borderline lesions was reviewed to identify follow-up regimes and outcomes.
Results
After excluding repeat patient entries (N=24) and histopathology not related to our unit (N=3), 99 patients were analysed. 15 had Phyllodes at biopsy but non-Phyllodes lesions following excision. 61 (median age 34 years) had benign Phyllodes, 19 (median age 47) were borderline and four (median age 73) had malignant Phyllodes tumours. Benign recurrence occurred in six patients with benign tumours (9.8%), with no recurrence in the borderline group and no malignancies identified. Excluding those lost to follow-up (11.5% benign and 10.5% borderline), most had a five-year follow-up plan (52%; 53% respectively) but a proportion were not clinically followed up (11.5%; 5% respectively). The rest (25%; 31.5% respectively) were followed up for less than 5 years. Two patients with recurrent benign Phyllodes tumours sought risk-reducing mastectomies.
Conclusions
In our series, benign and borderline Phyllodes, though sometimes recurrent, did not result in malignancy. Consensus regarding follow-up should be reached. Follow-up may be associated with increased biopsy rates and resultant patient anxiety for benign disease.
Phyllodes tumours of the breast are uncommon fibroepithelial neoplasms usually managed with surgical excision. They are classified as benign, borderline or malignant but all carry a risk of local recurrence. The value of clinical follow-up for excised benign and borderline lesions remains unclear. This study assesses ten years of experience in our unit.
Methods
Retrospective analysis using the pathology SNOMED database identified 126 Phyllodes lesions. Clinical data on those with benign and borderline lesions was reviewed to identify follow-up regimes and outcomes.
Results
After excluding repeat patient entries (N=24) and histopathology not related to our unit (N=3), 99 patients were analysed. 15 had Phyllodes at biopsy but non-Phyllodes lesions following excision. 61 (median age 34 years) had benign Phyllodes, 19 (median age 47) were borderline and four (median age 73) had malignant Phyllodes tumours. Benign recurrence occurred in six patients with benign tumours (9.8%), with no recurrence in the borderline group and no malignancies identified. Excluding those lost to follow-up (11.5% benign and 10.5% borderline), most had a five-year follow-up plan (52%; 53% respectively) but a proportion were not clinically followed up (11.5%; 5% respectively). The rest (25%; 31.5% respectively) were followed up for less than 5 years. Two patients with recurrent benign Phyllodes tumours sought risk-reducing mastectomies.
Conclusions
In our series, benign and borderline Phyllodes, though sometimes recurrent, did not result in malignancy. Consensus regarding follow-up should be reached. Follow-up may be associated with increased biopsy rates and resultant patient anxiety for benign disease.
Introduction
Phyllodes tumours of the breast are uncommon fibroepithelial neoplasms usually managed with surgical excision. They are classified as benign, borderline or malignant but all carry a risk of local recurrence. The value of clinical follow-up for excised benign and borderline lesions remains unclear. This study assesses ten years of experience in our unit.
Methods
Retrospective analysis using the pathology SNOMED database identified 126 Phyllodes lesions. Clinical data on those with benign and borderline lesions was reviewed to identify follow-up regimes and outcomes.
Results
After excluding repeat patient entries (N=24) and histopathology not related to our unit (N=3), 99 patients were analysed. 15 had Phyllodes at biopsy but non-Phyllodes lesions following excision. 61 (median age 34 years) had benign Phyllodes, 19 (median age 47) were borderline and four (median age 73) had malignant Phyllodes tumours. Benign recurrence occurred in six patients with benign tumours (9.8%), with no recurrence in the borderline group and no malignancies identified. Excluding those lost to follow-up (11.5% benign and 10.5% borderline), most had a five-year follow-up plan (52%; 53% respectively) but a proportion were not clinically followed up (11.5%; 5% respectively). The rest (25%; 31.5% respectively) were followed up for less than 5 years. Two patients with recurrent benign Phyllodes tumours sought risk-reducing mastectomies.
Conclusions
In our series, benign and borderline Phyllodes, though sometimes recurrent, did not result in malignancy. Consensus regarding follow-up should be reached. Follow-up may be associated with increased biopsy rates and resultant patient anxiety for benign disease.
Phyllodes tumours of the breast are uncommon fibroepithelial neoplasms usually managed with surgical excision. They are classified as benign, borderline or malignant but all carry a risk of local recurrence. The value of clinical follow-up for excised benign and borderline lesions remains unclear. This study assesses ten years of experience in our unit.
Methods
Retrospective analysis using the pathology SNOMED database identified 126 Phyllodes lesions. Clinical data on those with benign and borderline lesions was reviewed to identify follow-up regimes and outcomes.
Results
After excluding repeat patient entries (N=24) and histopathology not related to our unit (N=3), 99 patients were analysed. 15 had Phyllodes at biopsy but non-Phyllodes lesions following excision. 61 (median age 34 years) had benign Phyllodes, 19 (median age 47) were borderline and four (median age 73) had malignant Phyllodes tumours. Benign recurrence occurred in six patients with benign tumours (9.8%), with no recurrence in the borderline group and no malignancies identified. Excluding those lost to follow-up (11.5% benign and 10.5% borderline), most had a five-year follow-up plan (52%; 53% respectively) but a proportion were not clinically followed up (11.5%; 5% respectively). The rest (25%; 31.5% respectively) were followed up for less than 5 years. Two patients with recurrent benign Phyllodes tumours sought risk-reducing mastectomies.
Conclusions
In our series, benign and borderline Phyllodes, though sometimes recurrent, did not result in malignancy. Consensus regarding follow-up should be reached. Follow-up may be associated with increased biopsy rates and resultant patient anxiety for benign disease.
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