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NCCN Guidelines Index
Breast Cancer Table of Contents
Discussion
Version2.2015, 03/11/2015© National Comprehensive Cancer Network, Inc. 2015,All rights reserved.The NCCN Guidelines
®
and this illustration may not be reproduced in any form without the express written permission of NCCN
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.
Note: All recommendations are category 2A unless otherwise indicated.
Clinical Trials: NCCN believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged.
PHYLL-1
NCCN Guidelines Version 2.2015
Phyllodes Tumor
CLINICAL PRESENTATION
WORKUP
FINDINGS
TREATMENT
a
FNA will not, and core biopsy may not distinguish fibroadenoma from a phyllodes tumor in most cases.
b
Excisional biopsy includes complete mass removal, but without the intent of obtaining surgical margins.
c
Wide excision means excision with the intention of obtaining surgical margins ≥1 cm. Narrow surgical margins are associated with heightened local recurrence risk, but
are not an absolute indication for mastectomy when partial mastectomy fails to achieve margin width ≥1 cm.
d
There are no prospective randomized data supporting the use of radiation treatment with phyllodes tumors. However, in the setting where additional recurrence would
create significant morbidity (eg, chest wall recurrence following mastectomy), radiation therapy may be considered following.the same principles that are applied to the
treatment of soft tissue sarcoma.
Clinical suspicion of phyllodes
tumor:
• Palpable mass
• Rapid growth
• Large size (>2 cm)
• Imaging with ultrasound
suggestive of fibroadenoma except
for size and/or history of growth
• History and
physical exam
• Ultrasound
• Mammogram for
women ≥30 y
Excisional
biopsy
b
Core needle
biopsy
a
Phyllodes tumor
includes benign,
borderline, and
malignant
Fibroadenoma
Invasive or
in situ cancer
Fibroadenoma
or indeterminate
Phyllodes tumor
includes benign,
borderline, and
malignant
Invasive or
in situ cancer
Observe
Wide excision
c
without axillary staging
d
See appropriate
guidelines
Excisional
biopsy
b
See findings
above
Wide excision
c
without axillary staging
d
See appropriate
guidelines