NCCN VERSION 2 2015

NCCN Guidelines Version 2.2015 Phyllodes Tumor

NCCN Guidelines Index Breast Cancer Table of Contents Discussion

CLINICAL PRESENTATION

WORKUP

FINDINGS

TREATMENT

Fibroadenoma

Observe

Phyllodes tumor includes benign, borderline, and malignant

Wide excision c without axillary staging d

Excisional biopsy b

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

Invasive or in situ cancer

See appropriate guidelines

• History and physical exam • Ultrasound • Mammogram for women ≥30 y

Excisional biopsy b

Fibroadenoma or indeterminate Phyllodes tumor includes benign, borderline, and malignant

See findings above

Wide excision c without axillary staging d

Core needle biopsy a

See appropriate guidelines

Invasive or in situ cancer

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.

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

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 ® .