{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T09:55:42Z","timestamp":1781776542187,"version":"3.54.5"},"reference-count":30,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Clin Pathol"],"accepted":{"date-parts":[[2026,4,4]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Although histological criteria underpin current classification, accurate risk stratification, particularly for borderline and malignant tumours, remains challenging.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed a 20-year institutional series of phyllodes tumours (PTs), integrating clinicopathological data with long-term clinical outcomes. Histological features were extracted from original pathology reports, with slide re-review where archival material was available.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 111 PTs, 80% were benign, 11% borderline and 9% malignant. The follow-up ranged from 0 to 20 years, with 11.3, 10.3 and 7.6 years for benign, borderline and malignant PT, respectively. Most patients underwent local excision; mastectomy was performed in 22% of malignant PT. Final positive margins were identified in 18% of benign, 8% of borderline and none of the malignant tumours. Adjuvant radiotherapy was administered in 18% of borderline and 67% of malignant PT. Local recurrence occurred in 3%, 11% and 22% of benign, borderline and malignant tumours, respectively. Distant metastases were observed exclusively in malignant PTs (33%, 3\/9 cases), two of which were preceded by local recurrence. Notably, two of the three metastatic malignant PTs showed either \u226410 mitoses\/10 high-power field or &lt;marked stromal atypia and lack of stromal overgrowth, which are required for diagnosis of malignant PT per WHO 5\n                      <jats:sup>th<\/jats:sup>\n                      edition recommendation. The low event rate precluded robust multivariable analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our results highlight the biological heterogeneity of malignant PTs and the limitations of rigid histological thresholds. These findings underscore the need for collaborative, multi-institutional prospective studies with standardised tumour sampling and reporting and molecular correlation to refine clinically meaningful risk stratification in PT.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/jcp-2026-210626","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T17:25:24Z","timestamp":1777569924000},"page":"459-466","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Phyllodes tumours of the breast: a 20-year institutional series with emphasis on criteria for malignancy"],"prefix":"10.1136","volume":"79","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-5843-3247","authenticated-orcid":false,"given":"Ping","family":"Tang","sequence":"first","affiliation":[{"name":"Department of Pathology, Loyola University Medical Center, Maywood, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessa","family":"Aragao","sequence":"additional","affiliation":[{"name":"Department of Pathology, Loyola University Medical Center, Maywood, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mia","family":"Yeager","sequence":"additional","affiliation":[{"name":"Department of Pathology, Loyola University Medical Center, Maywood, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Gordezky","sequence":"additional","affiliation":[{"name":"Department of Pathology, Loyola University Medical Center, Maywood, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nolan","family":"Donahue","sequence":"additional","affiliation":[{"name":"Department of Pathology, Loyola University Medical Center, Maywood, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lora","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Pathology, Loyola University Medical Center, Maywood, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiuzhen","family":"Duan","sequence":"additional","affiliation":[{"name":"Department of Pathology, Loyola University Medical Center, Maywood, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5009-5525","authenticated-orcid":false,"given":"Emad A","family":"Rakha","sequence":"additional","affiliation":[{"name":"Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1405-2878","authenticated-orcid":false,"given":"Puay Hoon","family":"Tan","sequence":"additional","affiliation":[{"name":"Luma Medical Centre, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"2026061802100671000_79.7.459.1","unstructured":"Rosen\u2019s breast pathology, 5th edition. 2021."},{"key":"2026061802100671000_79.7.459.2","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1038\/s41379-020-0583-3","article-title":"Fibroepithelial lesions revisited: implications for diagnosis and management","volume":"34","author":"Tan","year":"2021","journal-title":"Mod Pathol"},{"key":"2026061802100671000_79.7.459.3","doi-asserted-by":"crossref","first-page":"100734","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","year":"2025","journal-title":"Mod Pathol"},{"key":"2026061802100671000_79.7.459.4","unstructured":"The WHO classification of tumours, editorial board: breast tumour 5th edition. 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