) Both contributed equally as joint lead authors.

ABSTRACTS S67

a margin width but there is consensus that the margin should be “clear” of

disease. Anterior margin management is a common point of discussion in

multidisciplinary meetings, including whether to re-excise the margin. If

skin flaps are thin many would advocate there is no need for re-excision.

The aim of our audit was to evaluate the oncological safety of re-excision

in patients who have had a close anterior margin and the pathology of re-

excision surgery.

Methods: A retrospective audit was performed of all patients with

close margins at a single institution between 2000 e April 2008. Patients

were included following wide local excision surgery or mastectomy. Data

collected included original and re-excision histology, margin width, recur-

rence and adjuvant treatment.

Results: 3,513 patients were studied of which 445 had close margins

(<2 mm). 60 patients had a close anterior margin alone with all other mar-

gins being clear. 59 patients had re-excision surgery. 36 margins were close

to invasive carcinoma, 19 for DCIS, two both DCIS and invasive, one

LCIS and in two cases this was not reported. Four re-excision specimens

showed residual disease, in three cases this was DCIS and in one case re-

sidual invasive carcinoma. Follow-up was for a median of 8 years 7 months

(range 5 years e 12 years 9 months). The recurrence rate was 2/59 (3%),

one occurring at 4 years and one at 9 years.

Conclusions: Patients with an involved anterior margin have a low

local recurrence rate with surgical re-excision of the margin. However,

re-excision surgery pathology rarely demonstrates residual disease.

http://dx.doi.org/10.1016/j.ejso.2013.07.198

Outcomes of surgery for screen detected breast lesions at the Royal

Alexandra Hospital, Paisley, over a 3 year period (2010e2013)

Vivienne Blackhall, Michael McKirdy, Katherine Krupa,

Abdulla Alhasso

Royal Alexandra Hospital, Paisley, Scotland, UK

Introduction: From 1988, 8 Scottish centres were designated to

carry out surgical management of screen detected breast lesions in the

national breast screening programme (NBSP). From March 2010 a

new unit at the RAH, Paisley joined the programme. This audit com-

pares the first 3 years of surgical work in this unit against published na-

tional guidelines.1

Methods: Prospective audit of all screen detected breast cancers over 3

years.

Results: 296 patients with 302 breast lesions were referred. 229 (76%)

of lesions were impalpable, 100% were identified at first operation. Non-

operative diagnosis was achieved in 211 invasive (95%) and 48 in-situ can-

cers (91%). 29 cases (10%) had diagnostic biopsy; 23 were impalpable and

6 palpable. The median weight of benign impalpable specimens was 12

grams, but 6 (26%) cases had a biopsy weighing � 20 grams. Following

initial surgery, 49 cases (18%) did not achieve disease free margins; all

had definitive surgery to clear margins. All patients having surgery for

invasive disease had axillary staging, 94% had sentinel node biopsy.

Two cases had fewer than the recommended number of nodes removed

at either axillary node clearance or sampling.

Conclusions: Our data supports new surgical centres being developed to

undertake NBSP surgical procedures, and we have achieved the majority of

national standards in our first three years of thiswork.An area for development

is ensuring that� 10% cases have benign diagnostic biopsy weighing� 20 g.

1. Quality assurance guideline for surgeons in breast cancer screening.

4th ed. NHSBSP Publication; March 2009.

http://dx.doi.org/10.1016/j.ejso.2013.07.199

Outcome of myxofibrosarcoma of soft tissue

Sultan Qasim

University Hospitals of Leicester NHS Trust, Leicester, UK

Introduction: Myxofibrosarcomas account for approximately 1% of

soft tissue sarcomas. They typically occur in the 6th to 8th decade and

have a high rate of local recurrence.

Methods:We present our results from the East Midlands Sarcoma Ser-

vice for treatment of myxofibrosarcoma with patients identified from a pa-

thology database.

This cohort consists of 67 patients from 1987 to 2012. The average age

of patients was 66 years, 42 male, 25 female. 7 patients were referred in to

the service with a recurrence.

43 tumours were superficial and 25 were deep. 53 were limb tumours, 14

truncal or head andneck.12were lowgrade, 23 intermediate and32highgrade.

Results: The number of cases presenting with metastasis was 2 (3%).

Wide margins were reported in 49 cases. 13 patients developed local recur-

rence and 3 subsequently developed metastatic disease.

In conclusion: Our results show that the majority of these tumours pre-

sent in males and beyond the age of 60. They are predominantly superficial

and majority of them were widely cleared with surgery. Our results show a

relatively lower recurrence rate than the reported literature.

http://dx.doi.org/10.1016/j.ejso.2013.07.200

Clinicopathological features predictive of unexpected invasive disease

and multiple operations in pure ductal carcinoma in situ

H. See1, D.M. Layfield1,2, M. Stahnke3, L. Hayward1, K. Squire2,

C. Summerhayes2, D. Rew2, G.T. Royle2, C. Rubin3, R. Oeppen3,*,

R.I. Cutress1,2,*1 University of Southampton, Southampton, UK2 Southampton Breast Surgical Unit, University Hospitals Southampton

NHS Foundation Trust, Level C, Princess Anne Hospital, Southampton, UK3Department of Radiology, University Hospital Southampton NHS

Foundation Trust, UK

Background: Pure DCIS manifests as ductal microcalcification on

mammography but may be wholly or partially uncalcified, affecting accu-

rate determination of extent pre-operatively. Additionally, a minority

of patients may have undiagnosed invasive foci. Consequently 25% of pa-

tients undergoing excision of DCIS require further surgery to re-excise mar-

gins or stage the axilla. Patients at highest risk of margin involvement or

unexpected invasion may benefit from additional pre-operative assessment.

Method: Retrospective review of all patients attending our breast

screening unit (1999e2009) treated for presumed pure DCIS. Mammo-

graphic records were reviewed by consultant radiologist. Logistic regres-

sion analysis identified factors predictive of requirement for further

surgery and presence of invasive component.

Results: 248 patients underwent surgery for presumed isolated DCIS

(Low/intermediate grade(LIG)¼93, high grade(HG)¼155); 49 (19.8%)

required further surgery. HG DCIS was associated with greater mammo-

graphic extent (mean¼32 mm, range 5e120 mm vs. 25 mm (2e100 mm);

P¼0.03) and higher incidence of mastectomy (38% vs. 25%; P¼0.04). Pa-

tients with HG disease were 2.3� more likely to have unexpected invasive

disease (95% Confidence Interval (CI)¼1.10e4.60; P¼0.03).

Negative ER status is more prevalent in HG DCIS (46/155 (30%) vs. 0/

93 (0%); P<0.001). Factors predictive of involvement of surgical margins

necessitating additional breast surgery included mammographic extent of

DCIS (OR¼1.05, 95%CI¼1.01e1.08; P<0.01) and negative ER-status

(OR¼4.21, 95% CI¼1.32e13.50; P¼0.015).Conclusion: Negative ER-status and greater extent of DCIS on

mammography independently predict patients likely to require further sur-

gery. Unexpected foci of invasion are more frequently found in HG DCIS.

Targeted use of additional imaging modalities may improve accuracy of

pre-operative assessment of DCIS in patients with these risk factors.

http://dx.doi.org/10.1016/j.ejso.2013.07.201