Benign Phyllodes Tumour of Breast: Management When Initial Excision Leaves Involved Margins

Clinical Scenario

Phyllodes tumours are biphasic breast tumours with both stromal and epithelial components. Benign phyllodes tumours account for the majority of cases. This protocol applies at the clinical decision point that arises after initial surgical management has not achieved the primary goal of complete excision.

When Initial Surgery Did Not Achieve Its Goal

The standard first-line approach for benign phyllodes tumour is breast-conserving surgery (BCS), aiming for complete excision of the tumour with the capsule intact and uninvolved (negative) margins. This protocol is indicated when that goal has not been met — specifically, when margins are found to be involved following BCS. At that point, the clinical pathway moves to a structured next step.

Next Clinical Step — Partial Overview

The next step involves a structured clinical discussion with the patient, weighing the implications of the involved margin against the risk of local recurrence. The full protocol outlines the clinical considerations, eligibility criteria, and decision framework guiding this stage of management.

Instant Access to Structured Evidence-Based Regimens

References

PT are biphasic with both stromal and epithelial components and are classified into three groups with the following proportions: benign, 50–70%; borderline, 12–26%; and malignant, 20–30%.
For benign PT, discuss with the patient the risks and benefits of re-excision versus risk of local recurrence if the margins are involved after BCS (evidence/grade V/A).

DOI: 10.1093/bjs/znaf152

View source ↗