Malignant Phyllodes Tumour of Breast: When Initial Surgery Did Not Achieve Clear Margins
This protocol addresses the specific situation of malignant phyllodes tumour of the breast without distant metastasis, in patients whose initial breast-conserving surgery did not achieve the target surgical margin. Phyllodes tumours are biphasic neoplasms with both stromal and epithelial components; malignant forms account for roughly 20–30% of cases and require careful surgical planning.
Previous Step — Goal Not Achieved
The initial approach for non-metastatic malignant phyllodes tumour is breast-conserving surgery targeting a clear surgical margin of at least 10 mm. Where achieving that margin requires mastectomy, breast reconstruction is considered. This protocol applies when that margin target was not reached — that is, the final surgical margins were narrower than 10 mm.
Next Step Partial Summary
When adequate margins were not achieved, surgical re-evaluation of the excision margin is a central consideration — the recommended approach depends on how close those margins are. The full structured protocol specifies when re-excision is recommended versus when a different management pathway may be appropriate after discussion with the patient.
References
DOI: 10.1093/bjs/znaf152
- 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 malignant PT, if the surgical excision margins are <5 mm after BCS, re-excision is recommended (evidence/grade II/A).
- For malignant PT, if the surgical excision margins are 5 to <10 mm after BCS, whilst the recommendation is to re-excise, consideration of clinical and imaging surveillance alone may be appropriate after discussion with the patient about the risks and benefits of each option (evidence/grade V/A).
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