West of Scotland breast sarcoma audit

Background: Breast sarcoma is rare, <1% of breast cancers, and <5% of sarcomas. Early referral to a specialist centre may ensure the first procedure achieves clear margins which may translate into a survival advantage. Methods: Patients were identified from the West of Scotland Cancer Registry and pathology databases. Demographics, tumour and treatment details was recorded. Results: 46 patients (Age 26-88) between 2006 - 2018. Of the 46 patients, 24 had angiosarcoma, 12 spindle cell, 7 pleomorphic/undifferentiated, 2 liposarcoma, and 1 fibrosarcoma. Most were high grade (37/46). 29/46 had previous same side breast cancer, 21/29 had prior radiotherapy for this. 42 patients underwent surgery. 24 underwent initial surgery in a sarcoma centre, with 2 positive margins (8.3%). 18 cases were operated at peripheral hospitals, with 7 postive margins (39%). The difference in positive margins was statistically significant (p=0.025). Wide local excision was the first procedure in 7 patients, all performed at peripheral hospitals. No wide local excisions were performed at the sarcoma centre, with a more aggressive surgical approach including radical mastectomy in most cases, up to and including rib resection (1 case). Conclusion: Higher rates of clear surgical margins are attained when the primary sarcoma resection is performed at a high-volume sarcoma centre. This may translate into an improved survival outcome. We advocate early referral to specialist sarcoma centres and intend to produce a Scottish Breast Sarcoma Guideline to facilitate this.