Fibroepithelial lesions: assessing the risk of malignant phyllodes tumors in the breast

Phyllodes tumors (PTs) of the breast are rare fibroepithelial tumors (FETs), accounting for approximately 0.5% of all breast tumors. The diagnostic interpretation of borderline fibroepithelial lesions often requires further investigations.

We used statistical analysis to evaluate the different surgical approaches, risk factors and prognosis during a five-year period, from January 2019 to December 2024, of women who underwent conservative surgeries for benign, borderline tumors and malignant breast tumors.

We examined a total of 481 breast tumors, with benign, borderline and reserved final diagnosis to paraffin, and discovered 35 FETs, corresponding to phyllodes-type tumors. Studies of enlarged PTs, which are often malignant on final paraffin results, are controversial regarding further postoperative treatment, because they require chemotherapy that is as aggressive as for soft tissue sarcomas, and also hormone therapy that has not shown long-term survival benefit yet. In order to improve the quality of life, survival rate, and disease management, the surgical team needs to be up to date with the latest protocols of management of the disease.

Management of breast tumors includes ultrasound examination, digital or three-dimensional (3D) mammography and magnetic resonance imaging (MRI) evaluation, while surgical management is consistent with core needle biopsy procedures and surgical excision known as tumorectomy, followed in certain cases by an enlarged sectorectomy.

Aggressive surgery is sometimes necessary to achieve oncological safety margins and prevent subsequent disease recurrence.