Margin Adequacy in Phyllodes Tumours Revisited: Reappraisal of the Evidence Base and Knowledge Gaps

Rakha, EA; Obiedat, SF; Quinn, C; Farshid, G; Shaaban, AM; Van Bockstal, MR; Li, X; Foschini, MP; Cserni, G; Schmitt, F; Varga, Z; Tse, G; Sharaf Eldean, ZM; van Deurzen, CHM; Decker, T; Brogi, E; Wen, H; Callagy, G; Yang, W; AlAjmi, Z; Altrabulsi, B; Walsh, D; Grobmyer, S; Matalkah, A; Gehani, SA; Ellis, IO; Schnitt, S; Fox, SB; Raymond, WA; Tan, PH; Dalton, L

Author(s): Rakha, EA; Obiedat, SF; Quinn, C; Farshid, G; Shaaban, AM; Van Bockstal, MR; Li, X; Foschini, MP; Cserni, G; Schmitt, F; Varga, Z; Tse, G; Sharaf Eldean, ZM; van Deurzen, CHM; Decker, T; Brogi, E; Wen, H; Callagy, G; Yang, W; AlAjmi, Z; Altrabulsi, B; Walsh, D; Grobmyer, S; Matalkah, A; Gehani, SA; Ellis, IO; Schnitt, S; Fox, SB; Raymond, WA; Tan, PH; Dalton, L;
Details: Publication Year 2026-09,Volume 39,Issue #9,Page 101034
Journal Title: Modern Pathology
Publication Type: Review
Abstract: The optimal surgical margin to minimise local recurrence (LR) and distant metastasis (DM) in phyllodes tumours (PTs) remains controversial. Despite multiple observational cohorts, variation between studies limits the interpretation of margin-outcome associations. We therefore performed a structured critical interpretative synthesis (CIS) to evaluate whether current evidence supports specific margin thresholds. The CIS incorporated a systematic review, random-effects meta-analysis, appraisal of existing meta-analyses and guidelines, and expert interpretative analysis of 40 single-cohort studies from 2015 to 2025 evaluating surgical margin width and outcomes in PT. Authors' recommendations regarding margin adequacy were extracted as interpretative "author conclusions". In parallel, LR and DM outcomes were pooled by tumour grade using random-effects models with prediction intervals. Final margin recommendations were derived by integrating CIS findings and multidisciplinary expert judgement. Current management guidelines do not recommend re-excision for positive or close margins in benign PTs. Contemporary guidelines are also concordant in advising negative margins for borderline and malignant PTs, although the specified margin width ranges from 1 mm to 10 mm. Within this range, no association has been established between increasing margin width and the risk of LR or malignant transformation upon LR. The estimated LR rates are 12.5% for borderline and 16.5% for malignant PTs. Malignant transformation on recurrence occurred in only 1% and 3% of all benign and borderline PTs, respectively. Around 14% of malignant PT metastasise, often without LR. Current heterogeneous evidence does not show lower recurrence with margins wider than a negative (≥1 mm) in PTs. For borderline and malignant PTs, a mandatory 10 mm threshold is insufficiently supported, as narrower negative margins may be adequate in selected cases. However, an optimal margin threshold cannot be defined from current data. These conclusions are practice-supporting rather than guideline-defining and reinforce the need for higher-quality evidence to establish harmonised, grade-specific margin recommendations.
Publisher: Elsevier
Keywords: breast cancer; margin width; phyllodes tumours; wide local excision
Department(s): Pathology
Publisher's Version: https://doi.org/10.1016/j.modpat.2026.101034
Open Access at Publisher's Site: https://doi.org/10.1016/j.modpat.2026.101034
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2026-07-07 05:56:14

Last Modified: 2026-08-04 05:57:44