title: How Wide Should Margins Be for Phyllodes Tumors of the Breast?
abstract: The surgical management of phyllodes tumors (PTs) is still controversial. Some studies have suggested surgical margins ≥1 cm, but recent studies suggested that negative margins could be appropriate regardless of their width. To evaluate recurrence rates of PTs following surgery according to margins. Retrospective study of women who attended a tertiary breast cancer reference center between 1998 and 2010: 142 patients with a PT diagnosis, either at minimally invasive breast biopsy or at surgery, were identified. Clinical, pathologic and follow-up characteristics were assessed. Among 140 patients who underwent surgery, 64.3% of biopsies accurately predicted the final PT diagnosis at surgery. Forty-two (42/87, 48.3%) PTs had positive margins. Twenty-one (21/42, 50.0%) patients had a surgical revision of margins. Only one (1/42, 2.4%) had margins greater or equal to 1 cm. After a median follow-up of 1.29 years in benign PTs, 4.99 years in borderline PTs, and 5.42 years in malignant PTs, there were five local recurrences, three in originally benign PTs and two in borderline PTs. All were managed with surgery. Four had initial margins ≤1 mm. One patient with borderline PT had a local recurrence and later progressed to regional recurrence and metastasis. Free surgical margins are necessary to treat PT, and margins of at least 1 mm might be sufficient to prevent recurrence. Core needle biopsy might not be the best diagnostic tool for PTs.
authors.affiliation: Département de biologie moléculaire, biochimie médicale et pathologie, Université Laval, Quebec City, Quebec, Canada.
authors.forename: Rosemarie
authors.initials: R
authors.lastname: Tremblay-LeMay
authors.affiliation: Centre de Recherche sur le Cancer, Université Laval, Quebec City, Quebec, Canada.|Axe oncologie, Centre de recherche du CHU de Québec - Université Laval, Quebec City, Quebec, Canada.|Centre des Maladies du Sein Deschênes-Fabia, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, Quebec City, Quebec, Canada.
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Hogue
authors.affiliation: Centre de Recherche sur le Cancer, Université Laval, Quebec City, Quebec, Canada.|Axe oncologie, Centre de recherche du CHU de Québec - Université Laval, Quebec City, Quebec, Canada.|Centre des Maladies du Sein Deschênes-Fabia, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, Quebec City, Quebec, Canada.|Département de chirurgie, Université Laval, Quebec City, Quebec, Canada.
authors.forename: Louise
authors.initials: L
authors.lastname: Provencher
authors.affiliation: Centre de Recherche sur le Cancer, Université Laval, Quebec City, Quebec, Canada.|Axe oncologie, Centre de recherche du CHU de Québec - Université Laval, Quebec City, Quebec, Canada.|Centre des Maladies du Sein Deschênes-Fabia, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, Quebec City, Quebec, Canada.|Département de chirurgie, Université Laval, Quebec City, Quebec, Canada.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Poirier
authors.affiliation: Centre de Recherche sur le Cancer, Université Laval, Quebec City, Quebec, Canada.|Axe oncologie, Centre de recherche du CHU de Québec - Université Laval, Quebec City, Quebec, Canada.|Centre des Maladies du Sein Deschênes-Fabia, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, Quebec City, Quebec, Canada.|Département de chirurgie, Université Laval, Quebec City, Quebec, Canada.
authors.forename: Éric
authors.initials: É
authors.lastname: Poirier
authors.affiliation: Centre de Recherche sur le Cancer, Université Laval, Quebec City, Quebec, Canada.|Axe oncologie, Centre de recherche du CHU de Québec - Université Laval, Quebec City, Quebec, Canada.|Centre des Maladies du Sein Deschênes-Fabia, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, Quebec City, Quebec, Canada.|Département de médecine sociale et préventive, Université Laval, Quebec City, Quebec, Canada.|Service de Pathologie, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, Quebec City, Quebec, Canada.
authors.forename: Sophie
authors.initials: S
authors.lastname: Laberge
authors.affiliation: Centre de Recherche sur le Cancer, Université Laval, Quebec City, Quebec, Canada.|Axe oncologie, Centre de recherche du CHU de Québec - Université Laval, Quebec City, Quebec, Canada.|Centre des Maladies du Sein Deschênes-Fabia, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, Quebec City, Quebec, Canada.|Département de médecine sociale et préventive, Université Laval, Quebec City, Quebec, Canada.
authors.forename: Caroline
authors.initials: C
authors.lastname: Diorio
authors.affiliation: Centre de Recherche sur le Cancer, Université Laval, Quebec City, Quebec, Canada.|Axe oncologie, Centre de recherche du CHU de Québec - Université Laval, Quebec City, Quebec, Canada.|Centre des Maladies du Sein Deschênes-Fabia, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, Quebec City, Quebec, Canada.|Département de chirurgie, Université Laval, Quebec City, Quebec, Canada.
authors.forename: Christine
authors.initials: C
authors.lastname: Desbiens
mesh_terms: D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000072662:Margins of Excision; D008408:Mastectomy / Q000706:statistics & numerical data; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D003557:Phyllodes Tumor / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D011792:Quebec / Q000453:epidemiology
keywords: breast disease; fibroadenoma; phyllodes tumor; surgical margins