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Ma X, Zhang L, Xiao Q, Huang Y, Lin L, Peng W, Gong J, Gu Y. Predicting Prognosis of Phyllodes Tumors Using a Mammography- and Magnetic Resonance Imaging-Based Radiomics Model: A Preliminary Study. Clin Breast Cancer 2024:S1526-8209(24)00119-8. [PMID: 38839461 DOI: 10.1016/j.clbc.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 04/25/2024] [Accepted: 05/13/2024] [Indexed: 06/07/2024]
Abstract
PURPOSE To investigate whether a radiomics model based on mammography (MG) and magnetic resonance imaging (MRI) can be used to predict disease-free survival (DFS) after phyllodes tumor (PT) surgery. METHOD About 131 PT patients who underwent MG and MRI before surgery between January 2010 and December 2020 were retrospectively enrolled, including 15 patients with recurrence and metastasis and 116 without recurrence. 884 and 3138 radiomic features were extracted from MG and MR images, respectively. Then, multiple radiomics models were established to predict the recurrence risk of the patients by applying a support vector machine classifier. The area under the ROC curve (AUC) was calculated to evaluate model performance. After dividing the patients into high- and low-risk groups based on the predicted radiomics scores, survival analysis was conducted to compare differences between the groups. RESULTS In total, 3 MG-related and 5 MRI-related radiomic models were established; the prediction performance of the T1WI feature fusion model was the best, with an AUC value of 0.93. After combining the features of MG and MRI, the AUC increased to 0.95. Furthermore, the MG, MRI and all-image radiomic models had statistically significant differences in survival between the high- and low-risk groups (P < .001). All-image radiomics model showed higher survival performance than the MG and MRI radiomics models alone. CONCLUSIONS Radiomics features based on preoperative MG and MR images can predict DFS after PT surgery, and the prediction score of the image radiomics model can be used as a potential indicator of recurrence risk.
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Affiliation(s)
- Xiaowen Ma
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Li Zhang
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qin Xiao
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yan Huang
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Luyi Lin
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Weijun Peng
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jing Gong
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Yajia Gu
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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van Olmen JP, Beerthuizen AWJ, Bekers EM, Viegen I, Drukker CA, Vrancken Peeters MJTFD, Bartels SAL, van Duijnhoven FH. Management of Benign Phyllodes Tumors: A Dutch Population-Based Retrospective Cohort Between 1989 and 2022. Ann Surg Oncol 2023; 30:8344-8352. [PMID: 37639031 DOI: 10.1245/s10434-023-14128-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/26/2023] [Indexed: 08/29/2023]
Abstract
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.
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Affiliation(s)
- Josefien P van Olmen
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Annemijn W J Beerthuizen
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Elise M Bekers
- Department of Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Isabella Viegen
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Caroline A Drukker
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | | | - Sanne A L Bartels
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Frederieke H van Duijnhoven
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
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Turashvili G, Ding Q, Liu Y, Peng L, Mrkonjic M, Mejbel H, Wang Y, Zhang H, Zhang G, Wang J, Wei S, Li X. Comprehensive Clinical-Pathologic Assessment of Malignant Phyllodes Tumors: Proposing Refined Diagnostic Criteria. Am J Surg Pathol 2023; 47:1195-1206. [PMID: 37694517 DOI: 10.1097/pas.0000000000002109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
The latest World Health Organization classification of breast tumors recommends diagnosing malignant phyllodes tumors (MPTs) when all 5 morphologic features are present: permeative borders, marked stromal cellularity, marked stromal cytologic atypia, ≥10 mitoses per 10 high-power fields (HPF), and stromal overgrowth. We assessed the performance of this recommendation to capture MPTs and features predictive of distant metastasis in a multi-institutional retrospective study. Of 65 MPTs, most cases had at least focally permeative borders (58, 89%), with marked stromal cellularity in 40 (61.5%), marked atypia in 38 (58.5%), ≥10 mitoses per 10 HPF in 50 (77%), and stromal overgrowth in 56 (86%). Distant metastases were observed in 20 (31%) patients (median follow-up 24.5 mo, 1 to 204). Only 13 of 65 (20%) cases had all 5 morphologic features, while only 7 of 20 (35%) cases with distant metastases had all 5 features. In univariate analysis, only marked stromal atypia ( P =0.004) and cellularity ( P =0.017) were associated with decreased distant metastasis-free survival. In multivariate Cox regression, the combination of stromal overgrowth, marked stromal cellularity, and atypia (C-index 0.721, 95% CI: 0.578, 0.863) was associated with decreased distant metastasis-free survival. The current World Health Organization recommendation will miss a significant number of MPTs with distant metastases. We propose refined diagnostic criteria for MPTs: (1) stromal overgrowth combined with ≥1 feature(s) (marked cellularity, marked atypia, or ≥10 mitoses per 10 HPF), or (2) in the absence of stromal overgrowth, marked cellularity combined with ≥1 feature(s) (permeative borders, marked atypia, or ≥10 mitoses per 10 HPF).
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Affiliation(s)
- Gulisa Turashvili
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, GA, USA
| | - Qingqing Ding
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yi Liu
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Limin Peng
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Miralem Mrkonjic
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Haider Mejbel
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Yihong Wang
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Brown University, Providence, RI, USA
| | - Huina Zhang
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Gloria Zhang
- Department of Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Jigang Wang
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Shi Wei
- Department of Pathology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Xiaoxian Li
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, GA, USA
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Yu CY, Huang TW, Tam KW. Management of phyllodes tumor: A systematic review and meta-analysis of real-world evidence. Int J Surg 2022; 107:106969. [PMID: 36328344 DOI: 10.1016/j.ijsu.2022.106969] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 09/01/2022] [Accepted: 10/22/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Phyllodes tumor is rare but has a high recurrence rate. Treatment modalities and clinicopathological prognostic factors for recurrence remain unclear. The synthesis of real-world data can enable the integration of sufficient evidence on optimal treatment for this population. METHODS We searched PubMed, Embase, and Cochrane Library databases for studies focusing on the management of phyllodes tumor including the surgical margin, different clinicopathological prognostic factors, and postoperative adjuvant radiotherapy versus no radiotherapy. RESULTS Fifty-two studies were retrieved. The pooled estimated recurrence rates of benign, borderline, and malignant tumors were 7.1%, 16.7%, and 25.1%, respectively. Surgical margins of 1 mm (odds ratio [OR]: 0.4, 95% confidence interval [CI]: 0.27-0.61) and 1 cm (OR: 0.45, 95% CI: 0.15-0.85) resulted in significantly higher recurrence rates. Postoperative adjuvant radiotherapy significantly reduced the recurrence rate of malignant tumors relative to no radiotherapy (P = 0.034) but did not significantly reduce the recurrence rates of overall and borderline tumors. Regarding clinicopathological features, moderate or severe stromal atypia and hypercellularity, stromal overgrowth, mitotic number of 5, tumor necrosis, tumor border, and margin status were determined as independent prognostic factors for recurrence, except a tumor size of 5 cm. CONCLUSION The ideal surgical margin for phyllodes tumor incision should be at least 1 cm in width. Adjuvant radiotherapy reduced the recurrence of malignant tumor. By identifying patients with poor clinicopathological risk factors, surgeons may reduce the recurrence rate of phyllodes tumor.
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Affiliation(s)
- Chia-Yun Yu
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
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Bi J, Tang H, Lin X, Yu X, Liang Y, Zhang L, Li Z, Shao M. Morphological features of 52 cases of breast phyllodes tumours with local recurrence. Virchows Arch 2022; 481:519-531. [PMID: 35906487 PMCID: PMC9534817 DOI: 10.1007/s00428-022-03383-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/02/2022] [Accepted: 07/16/2022] [Indexed: 12/02/2022]
Abstract
Typical phyllodes tumours (PTs) of the breast are fibroepithelial neoplasms characterised histologically by stromal hypercellularity and leaf-like structures. However, morphological changes may be atypical in some cases, increasing the difficulty of diagnosis and the likelihood of misdiagnosis. To provide more morphological clues for pathological diagnosis of PTs, we retrospectively analysed 52 PT cases with typical morphological features after recurrence, and summarized the clinicopathological characteristics of the paired primary tumours. We found five special histological features in the primary tumours distinct from classic PTs, namely (1) PTs with epithelioid feature (three cases); (2) PTs with gland-rich feature (eight cases); (3) PTs with fibroadenoma-like feature (20 cases); (4) PTs with myxoid fibroadenoma-like feature (five cases); and (5) PTs with pseudohemangiomatoid stromal hyperplasia–like feature (four cases). All the features can exist independently, and a few cases displayed more than two distinctive features at the same time. In this cohort of recurrent PTs, all the primary tumours were absent of recognisable stromal hypercellularity and leaf-like structures that are the critical diagnostic criteria of PTs; however, they showed some other non-classic characteristics which may provide significant clues for the diagnosis of PTs. Particularly, tumours with epithelioid feature displayed high grade at earlier stages, tumours with fibroadenoma-like feature were most likely to be confused with classical fibroadenomas, and tumours with myxoid feature were prone to be neglected because of their hypocellularity.
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Affiliation(s)
- Jiaxin Bi
- Department of Pathology, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, No.1 Fuhua Road, Futian District, Shenzhen, MD518033, Guangdong, China
| | - Hongping Tang
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong Province, China
| | - Xiao Lin
- Department of Pathology, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, No.1 Fuhua Road, Futian District, Shenzhen, MD518033, Guangdong, China
| | - Xuewen Yu
- Department of Pathology, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, No.1 Fuhua Road, Futian District, Shenzhen, MD518033, Guangdong, China
| | - Yingying Liang
- Department of Pathology, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, No.1 Fuhua Road, Futian District, Shenzhen, MD518033, Guangdong, China
| | - Lu Zhang
- Department of Pathology, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, No.1 Fuhua Road, Futian District, Shenzhen, MD518033, Guangdong, China
| | - Zhixin Li
- Department of Surgery, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong Province, China
| | - Mumin Shao
- Department of Pathology, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, No.1 Fuhua Road, Futian District, Shenzhen, MD518033, Guangdong, China.
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Wei Y, Yu Y, Ji Y, Zhong Y, Min N, Hu H, Guan Q, Li X. Surgical management in phyllodes tumors of the breast: a systematic review and meta-analysis. Gland Surg 2022; 11:513-523. [PMID: 35402210 PMCID: PMC8984980 DOI: 10.21037/gs-21-789] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/24/2022] [Indexed: 03/20/2024]
Abstract
BACKGROUND Information is still controversial in the studies regarding the current optimal surgical management of phyllodes tumors (PTs) of the breast. Local recurrence (LR) may occur with an upgraded in the pathological grade, influencing the prognosis of patients with PT. This systematic review and meta-analysis aimed to investigate the association of LR risk with margin status and margin width which could have significant implications on the surgical management of PT. METHODS Independent and comprehensive searches were performed by two authors through five databases including PubMed, Medline, Embase, ScienceDirect and Cochrane Library from January 1990 to October 2021. Studies investigating the association between margin width, margin status and LR rates were considered for inclusion. Study quality was evaluated using the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using RevMan5.3 software, and statistical heterogeneity was assessed using the Chi-square test and quantified using the I2 statistic. Visual inspection of funnel plots was used to judge publication bias. RESULTS A total of 34 articles were included in this article, all of which with NOS scores above 5. Regardless of the PT grade, positive margin significantly increased the risk of LR [odds ratio (OR) 3.64, 95% confidence interval (CI): 2.60-5.12]. No significant difference was found in the risk of LR between the margins <1 and ≥1 cm (OR 1.39, 95% CI: 0.67-2.92). For benign and borderline PTs, there were no significant differences of the LR risk between breast-conserving surgery (BCS) and mastectomy (benign OR 0.68, 95% CI: 0.12-3.78; borderline OR 1.14, 95% CI: 0.29-4.51). While the LR risk was significantly increased by BCS for malignant PT (OR 2.77, 95% CI: 1.33-5.74). DISCUSSION Different surgical management strategies should be considered for different PT grades. BCS was a feasible option and margins <1 cm was not significantly associated with LR risk for all grade of PT. After BCS, benign PT with positive margin could adopt the "wait and watch" strategy with regular follow-up, while borderline and malignant PTs were expected to underwent re-excision to ensure negative margins. More studies are still needed to clarify and update the existing conclusions and improve the prognosis of PT patients.
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Affiliation(s)
- Yufan Wei
- School of Medicine, Nankai University, Tianjin, China
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yanying Yu
- Eight-Year MD Program, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yashuang Ji
- Department of Galactophore Surgery, Tongzhou District Hospital of Integrated TCM & Western Medicine, Beijing, China
| | - Yuting Zhong
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Ningning Min
- School of Medicine, Nankai University, Tianjin, China
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Huayu Hu
- School of Medicine, Nankai University, Tianjin, China
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Qingyu Guan
- School of Medicine, Nankai University, Tianjin, China
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiru Li
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
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Li X, Guo H, Cong C, Liu H, Zhang C, Luo X, Zhong P, Shi H, Fang J, Wang Y. The Potential Value of Texture Analysis Based on Dynamic Contrast-Enhanced MR Images in the Grading of Breast Phyllode Tumors. Front Oncol 2021; 11:745242. [PMID: 34858821 PMCID: PMC8631520 DOI: 10.3389/fonc.2021.745242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/18/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose To explore the value of texture analysis (TA) based on dynamic contrast-enhanced MR (DCE-MR) images in the differential diagnosis of benign phyllode tumors (BPTs) and borderline/malignant phyllode tumors (BMPTs). Methods A total of 47 patients with histologically proven phyllode tumors (PTs) from November 2012 to March 2020, including 26 benign BPTs and 21 BMPTs, were enrolled in this retrospective study. The whole-tumor texture features based on DCE-MR images were calculated, and conventional imaging findings were evaluated according to the Breast Imaging Reporting and Data System (BI-RADS). The differences in the texture features and imaging findings between BPTs and BMPTs were compared; the variates with statistical significance were entered into logistic regression analysis. The receiver operating characteristic (ROC) curve was used to assess the diagnostic performance of models from image-based analysis, TA, and the combination of these two approaches. Results Regarding texture features, three features of the histogram, two features of the gray-level co-occurrence matrix (GLCM), and three features of the run-length matrix (RLM) showed significant differences between the two groups (all p < 0.05). Regarding imaging findings, however, only cystic wall morphology showed significant differences between the two groups (p = 0.014). The areas under the ROC curve (AUCs) of image-based analysis, TA, and the combination of these two approaches were 0.687 (95% CI, 0.518–0.825, p = 0.014), 0.886 (95% CI, 0.760–0.960, p < 0.0001), and 0.894 (95% CI, 0.754–0.970, p < 0.0001), respectively. Conclusion TA based on DCE-MR images has potential in differentiating BPTs and BMPTs.
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Affiliation(s)
- Xiaoguang Li
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, China
| | - Hong Guo
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, China
| | - Chao Cong
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, China
| | | | - Chunlai Zhang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, China
| | - Xiangguo Luo
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, China
| | - Peng Zhong
- Department of Pathology, Daping Hospital, Army Medical University, Chongqing, China
| | - Hang Shi
- Department of Information, Daping Hospital, Army Medical University, Chongqing, China
| | - Jingqin Fang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, China
| | - Yi Wang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, China
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Mohan SC, Tseng J, Angarita S, Marumoto A, Dadmanesh F, Amersi F, Giuliano A, Chung A. Clinicopathologic Characteristics and Patient Outcomes of Phyllodes Tumors: A Single Institution Experience. Am Surg 2021; 87:1533-1538. [PMID: 34689588 DOI: 10.1177/00031348211051673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Phyllodes tumors (PT) are rare fibroepithelial neoplasms that are classified as benign, borderline, or malignant. Patients with PT diagnosed between 2009 and 2019 were identified from a prospectively maintained single institutional database. 76 patients with PT were included; 47 (61.8%) were benign, 9 (11.8%) were borderline, and 20 (26.3%) were malignant. The mean age at diagnosis was 52. Surgical treatment of benign PT included excisional biopsy in 31 (66.0%) patients, segmental mastectomy in 15 (31.9%), and mastectomy in 1 (2.1%). Among patients with borderline PT, operative management was excisional biopsy in 4 (44.4%) and segmental mastectomy in 5 (55.6%). Of those with malignant PT, 7 (35.0%) were treated with excisional biopsy alone, 9 (45.0%) had lumpectomy (segmental mastectomy), and 4 (20.0%) underwent mastectomy. Malignant PT had a higher rate of necrosis compared to borderline or benign PT (25.0% vs 0% vs 4.3%, P = .016). Four patients had recurrent PT. Final positive margins were associated with recurrence (P = .044). The median overall follow-up time was 86.3 months (range 1.5-1414.1 months), and no deaths occurred among patients with malignant PT. Overall, recurrence rates of PT are low but may be increased by presence of positive margins.
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Affiliation(s)
- Srivarshini Cherukupalli Mohan
- Saul and Joyce Brandman Breast Center at Samuel Oschin Cancer Center, Department of Surgery, 22494Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Joshua Tseng
- Saul and Joyce Brandman Breast Center at Samuel Oschin Cancer Center, Department of Surgery, 22494Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Stephanie Angarita
- Saul and Joyce Brandman Breast Center at Samuel Oschin Cancer Center, Department of Surgery, 22494Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Ashley Marumoto
- Saul and Joyce Brandman Breast Center at Samuel Oschin Cancer Center, Department of Surgery, 22494Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Farnaz Dadmanesh
- Saul and Joyce Brandman Breast Center at Samuel Oschin Cancer Center, Department of Surgery, 22494Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Farin Amersi
- Saul and Joyce Brandman Breast Center at Samuel Oschin Cancer Center, Department of Surgery, 22494Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Armando Giuliano
- Saul and Joyce Brandman Breast Center at Samuel Oschin Cancer Center, Department of Surgery, 22494Cedars Sinai Medical Center, Los Angeles, CA, USA
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Di Liso E, Bottosso M, Lo Mele M, Tsvetkova V, Dieci MV, Miglietta F, Falci C, Faggioni G, Tasca G, Giorgi CA, Giarratano T, Mioranza E, Michieletto S, Saibene T, Dei Tos AP, Conte P, Guarneri V. Prognostic factors in phyllodes tumours of the breast: retrospective study on 166 consecutive cases. ESMO Open 2021; 5:e000843. [PMID: 33020219 PMCID: PMC7537333 DOI: 10.1136/esmoopen-2020-000843] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/13/2020] [Accepted: 08/15/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Phyllodes tumours (PTs) are rare fibroepithelial tumours accounting for <1% of all breast tumours. We assessed clinicopathological features and their prognostic effect in a single-institution patients' cohort. METHODS Patients diagnosed with PT between 2001 and 2018 at our institution were identified. Clinical, surgical and pathological features were collected. Phyllodes-related relapse was defined as locoregional or distant recurrence (contralateral excluded), whichever first. RESULTS A total of 166 patients were included: 115 with benign, 30 with borderline and 21 with malignant PTs. Features associated with malignant PT were younger age, larger T size, higher mitotic count, marked cytological atypia, stromal overgrowth, stromal hypercellularity, necrosis and heterologous differentiation (all p<0.01). The majority of patients with malignant PT underwent mastectomy (63.2% vs 3% of benign/borderline, p<0.001) and had negative surgical margins (83.3%). 4-year cumulative phyllodes-related relapse incidence was 7% for benign/borderline PT and 21.3% for malignant PT (p=0.107). In the entire cohort, marked cellular atypia and heterologous differentiation were associated with worse phyllodes-related relapse-free survival (HR 14.10, p=0.036 for marked vs mild atypia; HR 4.21, p=0.031 for heterologous differentiation present vs absent). For patients with benign PT, larger tumour size was associated with worse phyllodes-related relapse-free survival (HR 9.67, p=0.013 for T>5 cm vs T≤2 cm). Higher tumour-infiltrating lymphocytes (TILs) were associated with borderline and malignant PT (p=0.023); TILs were not associated with phyllodes-related relapse-free survival (HR 0.58, p=0.361 for TILs>2% vs≤2%). Overall, four patients died because of PT: three patients with malignant and one with borderline PT. CONCLUSIONS Patients with malignant PT had increased rates of phyllodes-related relapse and phyllodes-related death. Cellular atypia and heterologous differentiation were poor prognostic factors in the entire cohort; large tumour size was associated with an increased risk of phyllodes-related relapse in benign PT.
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Affiliation(s)
- Elisabetta Di Liso
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova, Italy
| | - Michele Bottosso
- Medical Oncology 2, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padova, Italy
| | - Marcello Lo Mele
- Department of Pathology, Padua University Hospital, Padova, Italy
| | - Vassilena Tsvetkova
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova, Italy
| | - Maria Vittoria Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova, Italy; Medical Oncology 2, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padova, Italy.
| | - Federica Miglietta
- Medical Oncology 2, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padova, Italy
| | - Cristina Falci
- Medical Oncology 2, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padova, Italy
| | - Giovanni Faggioni
- Medical Oncology 2, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padova, Italy
| | - Giulia Tasca
- Medical Oncology 2, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padova, Italy
| | - Carlo Alberto Giorgi
- Medical Oncology 2, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padova, Italy
| | - Tommaso Giarratano
- Medical Oncology 2, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padova, Italy
| | - Eleonora Mioranza
- Medical Oncology 2, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padova, Italy
| | - Silvia Michieletto
- Breast Surgery, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padova, Italy
| | - Tania Saibene
- Breast Surgery, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padova, Italy
| | - Angelo Paolo Dei Tos
- Department of Pathology, Padua University Hospital, Padova, Italy; Department of Medicine (DIMED), Anatomic Pathology, University of Padua, Padova, Italy
| | - PierFranco Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova, Italy; Medical Oncology 2, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padova, Italy
| | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova, Italy; Medical Oncology 2, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padova, Italy
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10
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Bogach J, Shakeel S, Wright FC, Hong NJL. Phyllodes Tumors: A Scoping Review of the Literature. Ann Surg Oncol 2021; 29:446-459. [PMID: 34296360 DOI: 10.1245/s10434-021-10468-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/29/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE Phyllodes tumors are rare tumors of the breast, with most literature being retrospective with limited guidelines on the management of these patients. Scoping review was performed to highlight themes and gaps in the available literature. METHODS A scoping review of the literature was performed as per PRISMA-ScR guidelines with titles, abstracts, and full texts reviewed in duplicate. Data were abstracted and summarized in categories of diagnostics, surgical management, adjuvant therapies, treatment of recurrence, and surveillance. Quality assessment was performed for each paper. RESULTS The search identified 4498 references, 434 full-text papers were reviewed, and 183 papers were included. Ultrasound, magnetic resonance imaging, and core needle biopsy are valuable preoperative diagnostics tools. Pathology reporting should include stromal overgrowth, stromal cellularity, nuclear atypia, mitotic rate, borders, and presence of heterologous elements. Ki67 may have a role in grading and prognosticating. Breast conservation is safe in all grades of phyllodes but may be associated with increased local recurrence in malignant phyllodes. Surgical margins should depend on grade. Axillary node positivity rate is very low, even with clinically enlarged lymph nodes. Adjuvant radiation is a useful tool to decrease local recurrence in malignant phyllodes tumors, tumors > 5 cm, age < 45 years, close margins, and breast conservation. There is no evidence supporting adjuvant chemotherapy. Recurrence can be managed with repeat wide excision; however, mastectomy is associated with lower re-recurrence. Surveillance protocols are variable in the literature. CONCLUSIONS There is heterogeneity in the literature on phyllodes tumors. Consensus guidelines based on the literature will help provide evidence-based care.
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Affiliation(s)
- Jessica Bogach
- Department of Surgery, McMaster University, Hamilton, ON, Canada.
| | - Saad Shakeel
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Frances C Wright
- Department of Surgery, University of Toronto, Toronto, ON, Canada.,Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Nicole J Look Hong
- Department of Surgery, University of Toronto, Toronto, ON, Canada.,Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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11
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Li X, Jiang N, Zhang C, Luo X, Zhong P, Fang J. Value of conventional magnetic resonance imaging texture analysis in the differential diagnosis of benign and borderline/malignant phyllodes tumors of the breast. Cancer Imaging 2021; 21:29. [PMID: 33712070 PMCID: PMC7953576 DOI: 10.1186/s40644-021-00398-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine the potential value of magnetic resonance imaging (MRI) texture analysis (TA) in differentiating between benign and borderline/malignant phyllodes tumors of the breast. METHODS The preoperative MRI data of 25 patients with benign phyllodes tumors (BPTs) and 19 patients with borderline/malignant phyllodes tumors (BMPTs) were retrospectively analyzed. A gray-level histogram and gray-level cooccurrence matrix (GLCM) were used for TA with fat-suppressed T2-weighted imaging (FS-T2WI), diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC) images, and 2- and 7-min postcontrast T1W images on dynamic contrast-enhanced MRI (DCE-T1WI2min and DCE-T1WI7min) between BPTs and BMPTs. Independent sample t-test and Mann-Whitney U test were performed for intergroup comparison. A regression model was established by using binary logistic regression analysis, and receiver operating characteristic (ROC) curve analysis was carried out to evaluate diagnostic efficiency. RESULTS For ADC images, the texture parameters angular second moment (ASM), correlation, contrast, entropy and the minimum gray values of ADC images (ADCMinimum) showed significant differences between the BPT group and BMPT group (all p<0.05). The parameter entropy of FS-T2WI and the maximum gray values and kurtosis of the tumor solid region of DCE-T1WI7min also showed significant differences between these two groups. Except for ADCMinimum, angular second moment of FS-T2WI (FS-T2WIASM), and the maximum gray values of DCE-T1WI7min (DCE-T1WI7min-Maximum) of the tumor solid region, the AUC values of other positive texture parameters mentioned above were greater than 0.75. Binary logistic regression analysis demonstrated that the contrast of ADC images (ADCContrast) and entropy of FS-T2WI (FS-T2WIEntropy) could be considered independent texture variables for the differential diagnosis of BPTs and BMPTs. Combined, the AUC of these parameters was 0.891 (95% CI: 0.793-0.988), with a sensitivity of 84.2% and a specificity of up to 89.0%. CONCLUSION Texture analysis could be helpful in improving the diagnostic efficacy of conventional MR images in differentiating BPTs and BMPTs.
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Affiliation(s)
- Xiaoguang Li
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Nianping Jiang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Chunlai Zhang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Xiangguo Luo
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Peng Zhong
- Department of Pathology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Jingqin Fang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, 400042, China.
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12
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Choi JE, Kang SH, Tan PH, Bae YK. Recurrence prediction for breast phyllodes tumours: validation of the Singapore nomogram in Korean women. J Clin Pathol 2020; 75:159-163. [PMID: 33376198 DOI: 10.1136/jclinpath-2020-207093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/16/2020] [Accepted: 12/07/2020] [Indexed: 01/12/2023]
Abstract
AIM The Singapore nomogram was developed to predict recurrence risk of phyllodes tumours (PTs) of the breast based on histological features of stromal atypia, stromal mitoses, stromal overgrowth and surgical margin status. We aimed to validate the utility of the Singapore nomogram in a Korean PT cohort. METHODS One hundred and twenty-four patients with Korean PT who underwent surgical resection between 1996 and 2015 were included in this study. Pathology reports and slides were reviewed to obtain histopathologic features and acquire Singapore nomogram scores. The probability of concordance between predicted and observed survivals by means of the Singapore nomogram was evaluated using a concordance index (C-index). RESULTS Of the 124 cases, 57 (46%) were diagnosed as benign, 50 (40.3%) as borderline and 17 (13.7%) as malignant. Recurrences occurred in 25 (20.2%) patients. Univariate analysis showed PTs with higher stromal mitotic counts, marked stromal cellularity, stromal overgrowth, positive surgical margin, marked stromal atypia or a malignant grade presented higher risks of recurrence. Multivariate analysis showed stromal mitoses and surgical margin status independently predicted recurrence-free survival. Patients with high nomogram scores were at greater risk of recurrence (HR=1.05, 95% CI: 1.02 to 1.07, p<0.001) with a C-index of 0.762. CONCLUSION The Singapore nomogram provided a useful means of predicting PT outcomes in a Korean PT cohort.
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Affiliation(s)
- Jung Eun Choi
- Department of Surgery, Yeungnam University College of Medicine, Daegu, The Republic of Korea
| | - Su Hwan Kang
- Department of Surgery, Yeungnam University College of Medicine, Daegu, The Republic of Korea
| | - Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Singapore
| | - Young Kyung Bae
- Deparment of Pathology, Yeungnam University College of Medicine, Daegu, The Republic of Korea
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13
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Yılmaz S, Aykota MR, Arman Karakaya Y, Özgen U, Erdem E. Phyllodes Tumors of the Breast: A Single-Center Experience. Eur J Breast Health 2020; 17:36-41. [PMID: 33796829 DOI: 10.4274/ejbh.2020.5961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 08/29/2020] [Indexed: 12/01/2022]
Abstract
Objective We aimed to analyze the clinicopathological findings, treatment approach, and treatmen outcomes in patients diagnosed with phyllodes tumor (PT). Materials and Methods The clinicopathological data of 26 patients with PT, who were treated between 2008 and 2019, were retrospectively analyzed. Results Mean age was 35.07±13.95 years (range: 14-71), while mean tumor size was 54.76±29.24 mm (range: 25-135). Benign, borderline, and malignant PT were detected in 18 (69.2%), 3 (11.5%), and 5 (19.2%) patients, respectively. Marginless excision was performed in 20 patients (76.9%), while six (23.1%) patients underwent mastectomy. A statistically significant correlation of tumor type with mean tumor size and mean age was observed (p=0.041 and p=0.013, respectively). Margin positivity on first excision was more frequent in the malignant tumors (p=0.02). No statistically significant correlation of PT type with presence of breast cancer in the family history, and tumor localization was observed (p=0.79 and p=0.13, respectively). Mean postoperative follow-up duration was 56 months (range: 6-147). Local recurrence was not observed in any of the patients. Lung and left vastus lateralis muscle metastases were encountered. The patient with lung metastasis became exitus because of the same reason 6 months after detection of the metastasis. Conclusion PT is a rare fibroepithelial tumor of the breast that is characterized by a mixed histology seen in younger ages when compared to the classical breast tumors. The probability of PT should be considered in the presence of a rapid-growing mass in the breast. In addition, it should also be considered that the contribution of imaging techniques may be limited.
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Affiliation(s)
- Sevda Yılmaz
- Department of General Surgery, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Muhammed Rasid Aykota
- Department of General Surgery, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Yeliz Arman Karakaya
- Department of Pathology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Utku Özgen
- Department of General Surgery, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Ergün Erdem
- Department of General Surgery, Pamukkale University Faculty of Medicine, Denizli, Turkey
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14
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Core needle biopsy diagnosis of fibroepithelial lesions of the breast: a diagnostic challenge. Pathology 2020; 52:627-634. [PMID: 32771211 DOI: 10.1016/j.pathol.2020.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/18/2020] [Accepted: 06/25/2020] [Indexed: 12/25/2022]
Abstract
Fibroepithelial lesions (FEL) of the breast are biphasic neoplasms consisting of proliferative epithelial and stromal components and include fibroadenoma, phyllodes tumour and periductal stromal tumour. Core needle biopsy (CNB) is a commonly used diagnostic modality for investigation of breast lesions. As the accurate diagnosis of FEL requires integrated assessment of both epithelial and stromal components, this may create problems in small biopsies with limited sampling. In this review, common problems encountered in CNB of FEL are discussed, including establishing a diagnosis of borderline/malignant phyllodes tumour in a biopsy consisting of malignant spindle cells, differentiating phyllodes tumour from fibroadenoma on CNB, grading of phyllodes tumour of intermediate histological grade and assessment of periductal stromal tumours. The approaches are detailed systematically based on histology, immunohistochemistry and molecular characterisation. This comprehensive approach may aid in dealing with the overlapping histological appearance of FEL and sampling limitations of CNB.
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15
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Wen B, Mousadoust D, Warburton R, Pao JS, Dingee C, Chen L, McKevitt E. Phyllodes tumours of the breast: Outcomes and recurrence after excision. Am J Surg 2020; 219:790-794. [PMID: 32145921 DOI: 10.1016/j.amjsurg.2020.02.048] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/22/2020] [Accepted: 02/24/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Wide excision margins are traditionally recommended for phyllodes tumours of the breast to reduce recurrence. Recent studies suggest margin status and histopathological features, excluding margin width, influence recurrence. This study evaluated treatment outcomes for phyllodes tumours and examined predictors of recurrence. METHODS Clinical and follow-up information for phyllodes tumours patients treated between 2008 and 2017 were obtained from chart review. Tumour subtype and histopathological features were determined from pathology reports. Primary endpoints were recurrence rate and time to recurrence or mortality. RESULTS Among 96 patients, there were 6 local and 1 distant recurrences. Overall recurrence rate was 7.3% and average time-to-recurrence was 13.7 months. Tumour size, margin status, necrosis, and mitoses were associated with recurrence; margin width was not. Two deaths (2.1%) from malignant phyllodes occurred. CONCLUSIONS Multiple histopathological features influence phyllodes recurrence. Wide excision and re-excising positive margins for benign tumours was not beneficial.
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Affiliation(s)
- Betty Wen
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
| | - Dorsa Mousadoust
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
| | - Rebecca Warburton
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
| | - Jin-Si Pao
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
| | - Carol Dingee
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
| | - Leo Chen
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
| | - Elaine McKevitt
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
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16
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Tsang JY, Tse GM. ASO Author Reflections: Resolving the Challenges in the Management of Mammary Phyllodes Tumor. Ann Surg Oncol 2019; 26:774-775. [PMID: 31605322 DOI: 10.1245/s10434-019-07930-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Julia Y Tsang
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Gary M Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong.
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