Borderline Phyllodes Tumour: When Breast-Conserving Surgery Did Not Achieve Clear Surgical Margins
Clinical Scenario
This protocol addresses patients with borderline phyllodes tumour of the breast who have already undergone initial breast-conserving surgery, but whose operation did not achieve the required clear surgical excision margin. Borderline phyllodes tumours represent approximately 12–26% of all phyllodes tumours and require precise margin control to guide subsequent management.
First-Line Goal Not Met — Escalation Triggered
First-line management of borderline phyllodes tumour targets breast-conserving surgery with a clear surgical excision margin of at least 5 mm; where this cannot be achieved, mastectomy with offered reconstruction is the alternative. This protocol is indicated when that primary goal — a clear excision margin of at least 5 mm — was not attained after initial surgery.
Next Management Step — Partial Overview
Management at this stage focuses on addressing the insufficient surgical margin. A further surgical approach targeting the margin is central to this protocol, though whether it is invariably required depends on the specific margin measurement. The full protocol defines the criteria and the alternative pathway available in certain situations.
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 borderline PT, if the surgical excision margins are <3 mm after BCS, re-excision is recommended (evidence/grade V/A).
- For borderline PT, if the surgical excision margins are 3 to <5 mm after BCS, consider re-excision versus clinical and imaging surveillance alone after discussion with the patient about the risks and benefits of each option (evidence/grade V/A).
DOI: 10.1093/bjs/znaf152
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