{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T05:50:42Z","timestamp":1791525042259,"version":"4.3.4"},"reference-count":16,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Histopathology"],"abstract":"<jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Phyllodes tumours of the breast (PTs) present complex histological features that challenge classification. The WHO 5th Edition (2019) defines malignancy based on five simultaneous criteria, which may under\u2010recognize tumours with metastatic potential. Alternative diagnostic systems have been proposed, but comparative data are limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>\n                      We reviewed 62 PTs diagnosed as borderline or malignant between 2015 and 2025. Histological features were re\u2010evaluated, and tumours were classified according to WHO (2019), Tan\n                      <jats:italic>et\u00a0al.<\/jats:italic>\n                      (2025), and the Refined Criteria (2023). After exclusion of 4 reclassified benign cases, 58 tumours (42 borderline, 16 malignant) were analysed. The mean patient age was 45\u2009years, and the mean tumour size was 6.7\u2009cm. After a median follow\u2010up of 31.7\u2009months, 6 borderline PTs recurred locally without metastasis. Among malignant PTs, seven developed distant metastases, with two disease\u2010related deaths. High stromal mitotic activity (\u226530\/10 HPF,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.005) and malignant heterologous elements (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001) were independently associated with metastasis. Tan\n                      <jats:italic>et\u00a0al.<\/jats:italic>\n                      's classification showed 97% concordance with WHO 2019, whereas the Refined Criteria reclassified 52% of borderline tumours as malignant; none of the reclassified tumours developed distant metastases during the available follow\u2010up.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      In this cohort, high stromal mitotic activity and malignant heterologous elements were the strongest predictors of recurrence in PTs. Tan\n                      <jats:italic>et\u00a0al.<\/jats:italic>\n                      's classification system demonstrated close concordance with the WHO (2019) criteria, whereas the Refined Criteria classified a substantially greater proportion of tumours as malignant without improving prognostic discrimination during the available follow\u2010up period. Comprehensive tumour sampling remains essential for accurate classification and reliable prognostic assessment of PTs of the breast.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/his.70295","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T05:10:27Z","timestamp":1791522627000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Do alternative classification systems improve prognostication in phyllodes tumours of the breast? A comparative clinicopathological study"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-0721-5270","authenticated-orcid":false,"given":"Yuri Merlotti","family":"Gomes","sequence":"first","affiliation":[{"name":"Department of Anatomic Pathology A.C.Camargo Cancer Center  Sao Paulo Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3466-5946","authenticated-orcid":false,"given":"Jo\u00e3o Pedro","family":"dos Reis da Costa","sequence":"additional","affiliation":[{"name":"Department of Anatomic Pathology A.C.Camargo Cancer Center  Sao Paulo Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6303-3659","authenticated-orcid":false,"given":"Roberto Bonfim Pimenta","family":"Peixoto","sequence":"additional","affiliation":[{"name":"Department of Anatomic Pathology A.C.Camargo Cancer Center  Sao Paulo Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4225-9896","authenticated-orcid":false,"given":"Jo\u00e3o Henrique","family":"Quint\u00e3o","sequence":"additional","affiliation":[{"name":"Department of Anatomic Pathology A.C.Camargo Cancer Center  Sao Paulo Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2717-3377","authenticated-orcid":false,"given":"Solange Moraes","family":"Sanches","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology A.C.Camargo Cancer Center  Sao Paulo Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0192-9885","authenticated-orcid":false,"given":"Almir Galv\u00e3o Vieira","family":"Bitencourt","sequence":"additional","affiliation":[{"name":"Department of Imaging A.C.Camargo Cancer Center  Sao Paulo Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4442-0870","authenticated-orcid":false,"given":"Fabiana Baroni Alves","family":"Makdissi","sequence":"additional","affiliation":[{"name":"Department of Breast Surgery A.C.Camargo Cancer Center  Sao Paulo Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5812-3084","authenticated-orcid":false,"given":"Renato Cagnacci","family":"Neto","sequence":"additional","affiliation":[{"name":"Department of Breast Surgery A.C.Camargo Cancer Center  Sao Paulo Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1628-0786","authenticated-orcid":false,"given":"Guilherme Rocha Melo","family":"Gondim","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology A.C.Camargo Cancer Center  Sao Paulo Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4157-4344","authenticated-orcid":false,"given":"Em\u00edlio Marcelo","family":"Pereira","sequence":"additional","affiliation":[{"name":"Department of Anatomic Pathology A.C.Camargo Cancer Center  Sao Paulo Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7675-9780","authenticated-orcid":false,"given":"Cynthia Aparecida Bueno","family":"de Toledo Os\u00f3rio","sequence":"additional","affiliation":[{"name":"Department of Anatomic Pathology A.C.Camargo Cancer Center  Sao Paulo Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2611-6832","authenticated-orcid":false,"given":"Helenice","family":"Gobbi","sequence":"additional","affiliation":[{"name":"Discipline of Special Pathology, Institute of Health Sciences Federal University of Triangulo Mineiro  Uberaba Minas Gerais Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2677-8043","authenticated-orcid":false,"given":"Marina","family":"De Brot","sequence":"additional","affiliation":[{"name":"Department of Anatomic Pathology A.C.Camargo Cancer Center  Sao Paulo Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5795-381X","authenticated-orcid":false,"given":"Rodrigo Fonseca","family":"Abreu","sequence":"additional","affiliation":[{"name":"Department of Anatomic Pathology A.C.Camargo Cancer Center  Sao Paulo Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,8]]},"reference":[{"key":"e_1_2_11_2_1","volume-title":"Breast tumours","author":"WHO Classification of Tumours Editorial Board","year":"2019"},{"key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1111\/his.12876","article-title":"Phyllodes tumours of the breast: A consensus review","volume":"68","author":"Tan BY","year":"2016","journal-title":"Histopathology"},{"key":"e_1_2_11_4_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.ijsu.2022.106969","article-title":"Management of phyllodes tumor: A systematic review and meta\u2010analysis of real\u2010world evidence","volume":"107","author":"Yu CY","year":"2022","journal-title":"Int. J. Surg."},{"key":"e_1_2_11_5_1","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1007\/s10549-020-05924-8","article-title":"Width of margins in phyllodes tumors of the breast: The controversy drags on?\u2010a systematic review and meta\u2010analysis","volume":"185","author":"Toussaint A","year":"2021","journal-title":"Breast Cancer Res. Treat."},{"key":"e_1_2_11_6_1","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.1245\/s10434-018-07134-5","article-title":"Local recurrence of benign, borderline, and malignant phyllodes tumors of the breast: A systematic review and meta\u2010analysis","volume":"26","author":"Lu Y","year":"2019","journal-title":"Ann. Surg. Oncol."},{"key":"e_1_2_11_7_1","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1097\/PAS.0000000000002109","article-title":"Comprehensive clinical\u2010pathologic assessment of malignant phyllodes tumors: Proposing refined diagnostic criteria","volume":"47","author":"Turashvili G","year":"2023","journal-title":"Am. J. Surg. Pathol."},{"key":"e_1_2_11_8_1","doi-asserted-by":"crossref","first-page":"1146","DOI":"10.1097\/PAS.0000000000002264","article-title":"Validation study of the newly proposed refined diagnostic criteria for malignant phyllodes tumor with 136 borderline and malignant phyllodes tumor cases","volume":"48","author":"Li X","year":"2024","journal-title":"Am. J. Surg. Pathol."},{"key":"e_1_2_11_9_1","unstructured":"National Comprehensive Cancer Network.NCCN Clinical Practice Guidelines in Oncology: Soft Tissue Sarcoma. Version 3.2026. Accessed March 16 2026.https:\/\/www.nccn.org."},{"key":"e_1_2_11_10_1","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1111\/his.14730","article-title":"Survey of recurrent diagnostic challenges in breast phyllodes tumours","volume":"82","author":"Tan BY","year":"2023","journal-title":"Histopathology"},{"key":"e_1_2_11_11_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.humpath.2025.105863","article-title":"Current understanding of phyllodes tumors of the breast: Tumor classification, molecular landscape, and best pathology practice","volume":"162","author":"Packer MDC","year":"2025","journal-title":"Hum. Pathol."},{"key":"e_1_2_11_12_1","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1111\/his.15455","article-title":"Malignant phyllodes tumours of the breast: The case for revising WHO's \u2018full house\u2019 diagnostic criteria","volume":"87","author":"Tan PH","year":"2025","journal-title":"Histopathology"},{"key":"e_1_2_11_13_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.modpat.2025.100734","article-title":"Classification of fibroepithelial lesions of the breast in Core needle biopsy with implications for further management","volume":"38","author":"Rakha EA","year":"2025","journal-title":"Mod. Pathol."},{"key":"e_1_2_11_14_1","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1016\/j.path.2025.05.005","article-title":"Fibroepithelial lesions: An update for daily practice (part\u2010I)","volume":"18","author":"Long Chow Z","year":"2025","journal-title":"Surg. Pathol. Clin."},{"key":"e_1_2_11_15_1","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1007\/s10549-014-2982-y","article-title":"Novel genetic aberrations in breast phyllodes tumours: Comparison between prognostically distinct groups","volume":"145","author":"Tan WJ","year":"2014","journal-title":"Breast Cancer Res. Treat."},{"key":"e_1_2_11_16_1","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1016\/j.pathol.2022.03.008","article-title":"Analysis of recurrent molecular alterations in phyllodes tumour of breast: Insights into prognosis and pathogenesis","volume":"54","author":"Tsang JY","year":"2022","journal-title":"Pathology"},{"key":"e_1_2_11_17_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.labinv.2025.104402","article-title":"Genomic determinants of adverse outcomes in phyllodes tumors","volume":"106","author":"Djerroudi L","year":"2026","journal-title":"Lab. Investig."}],"container-title":["Histopathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/his.70295","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/his.70295","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/his.70295","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T05:10:30Z","timestamp":1791522630000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/his.70295"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,8]]},"references-count":16,"alternative-id":["10.1111\/his.70295"],"URL":"https:\/\/doi.org\/10.1111\/his.70295","archive":["Portico"],"relation":{},"ISSN":["0309-0167","1365-2559"],"issn-type":[{"value":"0309-0167","type":"print"},{"value":"1365-2559","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,8]]},"assertion":[{"value":"2026-04-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-23","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"his.70295"}}