Phyllodes Tumors of the Breast in 2026: A Contemporary Narrative Review of Diagnosis, Surgical Margins, Prognosis, and Emerging Therapies.

Phyllodes tumors of the breast are rare fibroepithelial neoplasms characterized by significant heterogeneity regarding morphology, biological behavior, and clinical outcome. This review summarizes current developments in the diagnosis, histopathological and molecular classification, therapeutic management, and emerging technologies associated with phyllodes tumors of the breast. A literature search was conducted across PubMed/MEDLINE, Scopus, Embase, and Google Scholar, focusing on publications from the 2000-2026 period. The literature search covered publications from January 1, 2000, to September 30, 2026, and was last updated on September 30, 2026. Mammography, ultrasound, and magnetic resonance imaging contribute to preoperative assessment, although significant diagnostic overlap with fibroadenomas persists. Core needle biopsy is a key diagnostic tool, yet lesion heterogeneity can limit the accuracy of histological classification. Advances in molecular pathology have identified mutations and pathways associated with the progression and aggressiveness of phyllodes tumors, though these have not yet replaced morphological assessment. Surgical excision with negative margins remains the primary therapeutic approach, while the risk of local recurrence depends on histological grade, surgical margins, and other clinicopathological characteristics. Radiotherapy in phyllodes tumors of the breast appears to offer benefits primarily regarding local control in selected high-risk cases. Emerging technologies, including artificial intelligence, radiomics, and digital pathology, are proving to be promising tools for diagnosis, grading, and prognostic assessment. Overall, modern management of phyllodes tumors of the breast is shifting toward more personalized and multifactorial approaches.