Surgical margins for borderline and malignant phyllodes tumours

Ann R Coll Surg Engl. 2020 Mar;102(3):165-173. doi: 10.1308/rcsann.2019.0140. Epub 2020 Jan 10.

Abstract

Background: Phyllodes tumours represent less than 1% of all UK breast neoplasms. Histological features allow classification into benign, borderline or malignant, which has a significant impact on prognosis and recurrence. Currently, there is no consensus for the optimal surgical excision margin. This systematic review aims to provide a comparative summary of outcomes (local recurrence, metastasis and survival) for borderline and malignant phyllodes tumours resected with either ≥1cm or <1cm margins.

Methods: MEDLINE and Embase were systematically searched (1990 to July 2019), in line with PRISMA guidelines. Study quality was assessed using the Newcastle-Ottawa scale.

Results: Ten retrospective studies were included (Newcastle-Ottawa scale mean score: 5.6, range: 8-4). Nine reported local recurrence rates, four reported distant metastasis and four reported survival. Meta-analysis pooling demonstrated no statistically significant difference between <1cm and ≥1cm margins in terms of local recurrence rates (relative risk [RR] 1.43, 95% confidence interval [95% CI] 0.70 - 2.93; p=0.33, n=456), distant metastasis (RR 1.93, 95% CI 0.35 - 10.63; p=0.45, n=72) or mortality (RR 1.93, 95% CI 0.42 - 8.77; p=0.40, n=58) for borderline and malignant tumours. Additionally, two studies demonstrated no significant difference in local recurrence for borderline tumours excised with <0.1cm margins compared to ≥1cm.

Conclusion: Current evidence suggests that margins <1cm may provide adequate tumour excision. This could enable breast conservation in patients with smaller breast-to-tumour volume ratios, with improved cosmetic outcomes and patient satisfaction. A prospective, multi-institutional trial would be appropriate to further elucidate the safety of smaller margins.

Keywords: Borderline; Clearance; Malignant; Margin; Phyllodes tumour; Recurrence; Surgery; Survival.

Publication types

  • Systematic Review

MeSH terms

  • Breast Neoplasms / pathology
  • Breast Neoplasms / surgery*
  • Disease-Free Survival
  • Female
  • Humans
  • Margins of Excision*
  • Neoplasm Metastasis
  • Neoplasm Recurrence, Local / pathology*
  • Phyllodes Tumor / secondary
  • Phyllodes Tumor / surgery*
  • Survival Rate