) 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