Phyllodes tumours of the breast: a 20-year institutional series with emphasis on criteria for malignancy.
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BACKGROUND: Although histological criteria underpin current classification, accurate risk stratification, particularly for borderline and malignant tumours, remains challenging. METHODS: We analysed a 20-year institutional series of phyllodes tumours (PTs), integrating clinicopathological data with long-term clinical outcomes. Histological features were extracted from original pathology reports, with slide re-review where archival material was available. RESULTS: Among 111 PTs, 80% were benign, 11% borderline and 9% malignant. The follow-up ranged from 0 to 20 years, with 11.3, 10.3 and 7.6 years for benign, borderline and malignant PT, respectively. Most patients underwent local excision; mastectomy was performed in 22% of malignant PT. Final positive margins were identified in 18% of benign, 8% of borderline and none of the malignant tumours. Adjuvant radiotherapy was administered in 18% of borderline and 67% of malignant PT. Local recurrence occurred in 3%, 11% and 22% of benign, borderline and malignant tumours, respectively. Distant metastases were observed exclusively in malignant PTs (33%, 3/9 cases), two of which were preceded by local recurrence. Notably, two of the three metastatic malignant PTs showed either ≤10 mitoses/10 high-power field or <marked stromal atypia and lack of stromal overgrowth, which are required for diagnosis of malignant PT per WHO 5th edition recommendation. The low event rate precluded robust multivariable analysis. CONCLUSION: Our results highlight the biological heterogeneity of malignant PTs and the limitations of rigid histological thresholds. These findings underscore the need for collaborative, multi-institutional prospective studies with standardised tumour sampling and reporting and molecular correlation to refine clinically meaningful risk stratification in PT.