Aim To define a predictive model for clinical behaviour of breast phyllodes tumours (PT) using histological parameters and surgical margin status.
Methods Cases of breast PT diagnosed in the Department of Pathology Singapore General Hospital between January 1992 and December 2010 were stratified into benign, borderline and malignant grades based on a combination of histological parameters (stromal atypia, hypercellularity, mitoses, overgrowth and nature of tumour borders). Surgical margin status was assessed. Clinical follow-up and biostatistical modelling were accomplished.
Results Of 605 PT, 440 (72.7%) were benign, 111 (18.4%) borderline and 54 (8.9%) malignant. Recurrences, which were predominantly local, were documented in 80 (13.2%) women. Deaths from PT occurred in 12 (2%) women. Multivariate analysis revealed stromal atypia, overgrowth and surgical margins to be independently predictive of clinical behaviour, with mitoses achieving near significance. Stromal hypercellularity and tumour borders were not independently useful. A nomogram developed based on atypia, mitoses, overgrowth and surgical margins (AMOS criteria) could predict recurrence-free survival at 1, 3, 5 and 10 years. This nomogram was superior to a total histological score derived from adding values assigned to each of five histological parameters.
Conclusion A predictive nomogram based on three histological criteria and surgical margin status can be used to calculate recurrence-free survival of an individual woman diagnosed with PT. This can be applied for patient counselling and clinical management.
- surgical margin
- breast pathology
- breast cancer
- cancer research
- cancer genetics
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↵* Phyllodes Tumour Network Singapore:
Benita Tan, FRCS
Chow Yin Wong, FRCS
Department of General Surgery, Singapore General Hospital
Kong Wee Ong, FRCS
Wei Sean Yong, FRCS
Gay Hui Ho, FRCS
Department of Surgical Oncology, National Cancer Centre Singapore
Wei Seong Ooi, MRCP
Department of Medical Oncology, National Cancer Centre Singapore
Bin Tean Teh, PhD
National Cancer Centre—Van Andel Research Institute Translational Research Laboratory, Singapore.
Competing interests None.
Ethics approval Ethics approval was provided by Centralised Institutional Review Board, SingHealth.
Provenance and peer review Not commissioned; externally peer reviewed.