Surgical treatment of phyllodes tumor of the breast with the trend

Objective: Phyllodes tumors are composed of a benign epithelial component and a cellular spindle cell stroma that form a leaf-like structure. The purpose of this study was to define changes in patient characteristics, histopathologic parameters, and the outcome during two periods: before and after the introduction of core needle biopsy for preoperative diagnosis. Methods: Records were reviewed of 170 patients with phyllodes tumors who were managed surgically. Patients treated from 1997 to 2004 (n=101) were compared with patients treated from 2006 to 2013 (n=69). Results: The analysis of the two treatment periods revealed that the tumor size at diagnosis increased from 4.6cm during the earlier period to 7.0cm during the recent period (p<0.05). The number of patients undergoing wide excision significantly increased during the recent period. Multivariate analysis revealed that a positive surgical margin was the only independent predictor of recurrence with an increased hazard of 4.8. Conclusion: Wide excision with a clear margin is the first choice of current treatment for phyllodes tumors, even for malignant phyllodes tumors. However, this strategy does not further reduce local recurrence effectively, and core needle biopsy cannot be overstated in avoiding inappropriate initial surgery.