背景:乳腺叶状肿瘤很少见,他们的治疗仍有待讨论。它们被归类为良性的,边界线,或基于间质的组织病理学特征的恶性。这项研究证明了10年的恶性叶状病的诊断和治疗经验。
方法:在2003年至2013年我们的肉瘤多学科小组会议上讨论的所有诊断为恶性叶状的患者均被确定。患者人口统计学,活检细节,切除范围,最终病理学,重建,辅助治疗,评估了复发率和总生存期.
结果:在10年的时间里确定了30例患者。八个(26.7%)的诊断在完成切除后升级为恶性叶状,与最初的活检相比。在转介我们的服务之前,有9人(30%)在其他地方进行了乳房手术作为明确的治疗。其中4例(44.4%)需要更广泛的切除,3例发生转移(33.3%)并死亡。21名患者通过我们的服务进行了初次手术,其中3名(14.3%)死于疾病。总的来说,13例患者接受了根治术,92.3%有足够的切缘(组织学>1cm)且无局部复发,9例单纯乳房切除术22.2%,切缘充足,1例局部复发,8例局部广泛切除术,切缘充足,1例局部复发。
结论:对于恶性叶状患者,减少复发和提高生存率的最佳机会是适当的切除和根治术.对于临界病变,应考虑转介到专科中心,我们建议延迟重建,因为组织学升级为恶性肿瘤的机会。
BACKGROUND: Phyllodes tumours of the breast are rare, and their treatment is still subject to discussion. They are classified as benign, borderline, or malignant based on histopathological characteristics of the stroma. This study demonstrates 10 years\' experience in diagnosis and management of malignant phyllodes.
METHODS: All patients referred for discussion at our sarcoma multidisciplinary team meeting from 2003 to 2013 with a diagnosis of malignant phyllodes were identified. Patient demographics, biopsy details, excision extent, final pathology, reconstruction, adjuvant treatment, recurrence and overall survival were assessed.
RESULTS: Thirty patients were identified over the 10 year period. Eight (26.7 %) had their diagnosis upgraded to malignant phyllodes on completion excision, compared to initial biopsy. Nine (30 %) had breast surgery elsewhere as definitive treatment before referral to our service. Four of these (44.4 %) required more extensive excision and three developed metastases (33.3 %) and died. Twenty-one patients had primary surgery through our service and three (14.3 %) died from disease. Overall, 13 patients had radical mastectomy, 92.3 % with adequate margins (>1 cm histologically) and no local recurrence, 9 simple mastectomy 22.2 % with adequate margins and 1 local recurrence and 8 wide local excision with 37.5 % adequate margins and 1 local recurrence.
CONCLUSIONS: For malignant phyllodes patients, the best chance to reduce recurrence and improve survival is adequate excision and radical mastectomy should be considered. For borderline lesions, consideration should be given for referral to a specialist centre and we recommend delayed reconstruction, because of the chance of histological upgrade to malignancy.