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Surgical margins for borderline and malignant phyllodes tumours
1Croydon University Hospital, Croydon Health Services NHS Trust, Thornton Heath, UK.
Annals of the Royal College of Surgeons of England
|January 11, 2020
Summary
Surgical excision margins of less than 1cm appear adequate for borderline and malignant phyllodes tumours. This finding supports breast conservation, potentially improving cosmetic outcomes and patient satisfaction in women with phyllodes tumours.
Area of Science:
- Oncology
- Surgical Pathology
- Breast Surgery
Background:
- Phyllodes tumours are rare breast neoplasms, accounting for <1% of UK cases.
- Histological classification (benign, borderline, malignant) impacts prognosis and recurrence.
- Optimal surgical excision margins for phyllodes tumours lack consensus.
Purpose of the Study:
- To systematically review and compare outcomes for phyllodes tumours resected with margins <1cm versus ≥1cm.
- To evaluate the impact of excision margins on local recurrence, metastasis, and survival.
- To inform surgical practice regarding optimal margin size for phyllodes tumours.
Main Methods:
- Systematic literature search of MEDLINE and Embase (1990-2019) following PRISMA guidelines.
- Inclusion of 10 retrospective studies for analysis.
- Quality assessment using the Newcastle-Ottawa scale.
Main Results:
- Meta-analysis showed no significant difference in local recurrence, distant metastasis, or mortality between <1cm and ≥1cm margins for borderline and malignant phyllodes tumours.
- Specific analysis indicated no significant difference in local recurrence for borderline tumours with <0.1cm margins compared to ≥1cm margins.
- Pooled data included 456 patients for local recurrence, 72 for distant metastasis, and 58 for mortality.
Conclusions:
- Evidence suggests that margins <1cm may be sufficient for adequate tumour excision in phyllodes tumours.
- Smaller margins could facilitate breast conservation, improving cosmetic results and patient satisfaction.
- Further investigation via a prospective, multi-institutional trial is recommended to confirm the safety of smaller margins.
