Risk Factors of Pimiento et al for Local Recurrence of a Phyllodes Tumor

 

Patient selection: phyllodes tumors

 

Risk Factor	Comments
large tumor	mean size in Blacks 3.3 cm vs 4.3 cm in Caucasians
surgical margin positive or < 0.2 cm	preferred surgical margin is >= 1 cm with 0.2 cm is considered the minimum acceptable.
borderline or malignant histologic classification	classified as benign, borderline or malignant
mitotic rate	low if < 4 mitoses per 10 hpf, medium if 4 to 10 mitoses per 10 hpf, high if > 10 mitoses per 10 hpf

 

where:

• The cutoffs used in the original paper were per high power field (hpf) and should have been per 10 hpf.

• The larger the tumor the more difficult it is to achieve the acceptable surgical margin without a mastectomy.

• The mitotic rate is an important determinant for the histologic classification.

 

Reasons for mastectomy (page 539):

(1) cosmesis

(2) larger tumor

(3) failure of breast conservation related to margins

(4) recurrent disease

 

Radiation was given in some patients if the surgical margin was < 1 cm (page 539).

 

The authors noted that Blacks had the highest percent of low-grade phyllodes tumors (81%) while Hispanics had the lowest (47%). The mean size in Hispanics was 6.7 cm vs 3 to 4 cm in other racial groups.