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Please see: J Clin Pathol 2013;66:455

J Clin Pathol 65:69-76 doi:10.1136/jclinpath-2011-200368
  • Original article

Predicting clinical behaviour of breast phyllodes tumours: a nomogram based on histological criteria and surgical margins

  1. The Phyllodes Tumour Network Singapore*
  1. 1Department of Pathology, Singapore General Hospital, Singapore
  2. 2Department of Clinical Research, Singapore General Hospital, Singapore
  3. 3Department of Medical Oncology, National Cancer Centre Singapore, Singapore
  4. 4Institute of Bioengineering and Nanotechnology, Singapore
  1. Correspondence to Dr Puay Hoon Tan, Department of Pathology, Singapore General Hospital, Outram Road, Singapore 169608, Singapore; tan.puay.hoon{at}
  1. Contributors All authors contributed to the manuscript.

  • Accepted 24 August 2011
  • Published Online First 2 November 2011


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.


  • * 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.

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