Mitoses counting in phyllodes tumours: rationale for a standardized hotspot‐based approach

Background Breast phyllodes tumours (PTs) are rare biphasic fibroepithelial neoplasms, classified into benign, borderline and malignant categories. Stromal mitotic activity is a key criterion in grading PT, but the methodology for mitotic assessment has not been clearly articulated. Materials and methods We discuss the approach to determining stromal mitotic activity in PTs. Whether the most mitotically active area (hotspot) or an average count across several tumour regions should be adopted is reviewed. We also outline the operational protocol for mitotic hotspot evaluation, accounting for different microscope models with varying field diameters. Results A standardized method of determining stromal mitoses in PTs is recommended in order to improve interobserver reproducibility and accuracy in grading PTs. The application of digital tools in stromal mitotic counting is also addressed. Conclusion We advocate using the hotspot method of obtaining the highest stromal mitotic count, together with other histological parameters, to classify PTs.

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Publication Details

Journal
Histopathology
Published
2026-10-08
DOI
https://doi.org/10.1111/his.70293
Primary Topic
Breast Lesions and Carcinomas
Type
article
Field-Weighted Citation Impact
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article

Mitoses counting in phyllodes tumours: rationale for a standardized hotspot‐based approach

Mihir Ananta Gudi, Stuart J. Schnitt, Emad A. Rakha, Edward Jaya Hadi et al.
Histopathology
Breast Lesions and Carcinomas
article

Mitoses counting in phyllodes tumours: rationale for a standardized hotspot‐based approach

Mihir Ananta Gudi, Stuart J. Schnitt, Emad A. Rakha, Edward Jaya Hadi, Sunil R. Lakhani, Sandra A O'Toole, Gary Man-Kit Tse, Puay Hoon Tan, Ian Ogilvie Ellis, Aleš Ryška, Xiaoxian Li
article en

Abstract

Background Breast phyllodes tumours (PTs) are rare biphasic fibroepithelial neoplasms, classified into benign, borderline and malignant categories. Stromal mitotic activity is a key criterion in grading PT, but the methodology for mitotic assessment has not been clearly articulated. Materials and methods We discuss the approach to determining stromal mitotic activity in PTs. Whether the most mitotically active area (hotspot) or an average count across several tumour regions should be adopted is reviewed. We also outline the operational protocol for mitotic hotspot evaluation, accounting for different microscope models with varying field diameters. Results A standardized method of determining stromal mitoses in PTs is recommended in order to improve interobserver reproducibility and accuracy in grading PTs. The application of digital tools in stromal mitotic counting is also addressed. Conclusion We advocate using the hotspot method of obtaining the highest stromal mitotic count, together with other histological parameters, to classify PTs.

Histopathology
Beth Israel Deaconess Medical Center (US), Nottingham University Hospitals NHS Trust (GB), Harvard University (US), University of Nottingham (GB), Chinese University of Hong Kong (HK), East Carolina University (US), Royal Prince Alfred Hospital (AU), KK Women's and Children's Hospital (SG), University Hospital Hradec Králové (CZ), Sullivan Nicolaides Pathology (AU), Hamad Medical Corporation (QA)
Openalex Percentile: Top 12%
Breast Lesions and Carcinomas
DOISourceOpenAlex
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