Abstract：
Background. Classification of phyllodes tumors is challenging due unclear diagnostic criteria, recently addressed by consensus review criteria. Herein, we reviewed all malignant phyllodes tumor resections and reclassified them based on the consensus guidelines, correlating with outcome. We hypothesize that application of criteria would result in a significant proportion being \"down-graded\" to either borderline or benign phyllodes tumor. Methods. Primary resections of malignant phyllodes tumor were reviewed by four AP board-certified, breast fellowship-trained pathologists. Morphologic variables delineated in consensus guidelines (ie stromal cellularity, cellular atypia, tumor border, presence of heterologous elements, presence of stromal overgrowth) were evaluated. Following review, cases were reclassified as benign, borderline, or malignant. Results. Upon reclassification, 20% (5/20) cases were \"down-graded\" to borderline phyllodes tumor while 80% (15/20) remained malignant phyllodes tumor. Two morphologic features were statistically significant including broadly infiltrating tumor border in 80% (12/15) of malignant phyllodes tumors compared to none in borderline phyllodes tumor (0/5) (p = 0.004) and stromal overgrowth in 67% (10/15) of malignant phyllodes tumor compared to none in borderline phyllodes tumors (0/5) (p = 0.03). Upon review of the pathology reports, 30% (6/20) contained all 5 histomorphologic variables delineated in the consensus review criteria. Malignant phyllodes tumor resulted in five cases with recurrence (33.3%, 5/15) and three cases with metastases (20.0%, 3/15) and borderline phyllodes tumor resulted in one case with recurrence (20.0%, 1/5) and no metastases (0/5). Conclusion. The consensus guidelines for phyllodes tumor are useful for subclassification. We hypothesize that standardize reporting of the histomorphologic variables may lead to better consensus.
摘要：
背景。由于诊断标准不明确，叶状肿瘤的分类具有挑战性。最近通过共识审查标准解决。在这里，我们回顾了所有恶性叶状肿瘤切除术，并根据共识指南重新分类，与结果相关。我们假设标准的应用将导致相当大的比例“降级”到边缘或良性叶状肿瘤。方法。恶性叶状肿瘤的原发性切除由四个AP委员会认证，受过乳腺研究金训练的病理学家。共识指南中描述的形态学变量(即基质细胞数量，细胞异型性,肿瘤边界,异源元件的存在，基质过度生长的存在）进行了评估。审查后，病例被重新分类为良性，边界线，或恶性。结果。重新分类后，20%(5/20)病例“降级”为交界叶状肿瘤，80%(15/20)仍为恶性叶状肿瘤。两个形态学特征具有统计学意义，包括80％（12/15）的恶性叶状肿瘤广泛浸润的肿瘤边界，而交界叶状肿瘤（0/5）（p=0.004）和67％（10/15）的基质过度生长恶性叶状肿瘤与交界叶状肿瘤（0/5）（p=0.03）相比。在查看病理报告后，30％（6/20）包含共识审查标准中描述的所有5个组织形态学变量。恶性叶状肿瘤导致5例复发(33.3%,5/15）和3例转移（20.0％，3/15）和交界叶状肿瘤导致1例复发（20.0％，1/5）和无转移（0/5）。结论。叶状肿瘤的共识指南可用于亚分类。我们假设标准化的组织形态学变量报告可能会导致更好的共识。
