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J Clin Pathol. 2012 Jan;65(1):69-76. doi: 10.1136/jclinpath-2011-200368. Epub 2011 Nov 2.

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

Author information

1
Department of Pathology, Singapore General Hospital, Singapore. tan.puay.hoon@sgh.com.sg

Erratum in

  • J Clin Pathol. 2013 May;66(5):455-6.

Abstract

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.

PMID:
22049216
DOI:
10.1136/jclinpath-2011-200368
[Indexed for MEDLINE]

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