P138. Do patients diagnosed with phyllodes breast tumours need long term follow up

S S65 P137. Does introduction of Vacuum Assisted Biopsy (VAB) change rate of indeterminate breast lesions? Damian Mayo, Michael King, Lucy Mansfield, Constantinos Yiangou, Avi Agrawal Queen Alexandra Hospital, Portsmouth, UK Introduction: Vacuum Assisted Biopsy is increasingly used as a diagnostic tool for mammographic screen detected breast lesions. Our unit introduced VAB in June 2013. The aim of our study was to identify the rate of indeterminate (B3) biopsy results prior to and after the introduction of VAB. Methods: Our prospective screening database identified all stereotactic biopsies from June 2012 to May 2013 and all VABs from June 2013 to May 2014. The electronic pathology database and patient notes were used to review the histology of all B3 lesions over this time. Results: 136 Patients underwent stereotactic biopsies and were compared to 204 undergoing VABs. Mean age of patients was similar (60 versus 58 for stereotactic: VAB). There was no difference in the B3 rate for the 12 months prior to and after VAB introduction (12.5% vs 13.2%). There was an increased B2 detection rate (43.4 to 57.3%) and a reduced B1 rate (8.6 to 4.4%) with VAB use. Of those undergoing repeat biopsy, with VAB only 2 had a different result compared to 4 in the stereotactic group. On excision of the B3 lesions, 6 of the 28 VAB (21%) and 5 of the 17 (29%) stereotactic group had their histology upgraded to malignant. Conclusion: Introduction of VAB showed no difference in the rate of B3 lesions reported. However an increase in B2 results with reduced B1 rates could reduce the need for repeat biopsies and diagnostic surgical excision. http://dx.doi.org/10.1016/j.ejso.2015.03.175 P138. Do patients diagnosed with phyllodes breast tumours need long term follow up? Damian Mayo, Lucy Mansfield, Constantinos Yiangou, Avi Agrawal Queen Alexandra Hospital, Portsmouth, UK Introduction: There is currently no national consensus on the follow up of phyllodes breast tumours. Our unit protocol is for benign phyllodes breast tumours to be treated with marginal excision and for borderline/ malignant tumours to have margins similar to invasive breast tumours. Patients are then followed up routinely with clinical and mammographic surveillance. The aim of our study was to review all patients who had been diagnosed with phyllodes tumour over a 20 year period and look at the classification, excision margins and recurrence rates. Methods: Histology was reviewed from our prospectively collected breast database and all phyllodes tumours from 1996 to 2015 were identified. Patient demographics, classification of tumour, excision margins & recurrence rates were recorded from the pathology database and patient notes. Results: 74 phyllodes tumours were identified. 54 benign, 9 borderline & 11 malignant Phyllodes tumours were excised. There were 4 local recurrences, 1 in the benign group (1.8%), 1 in borderline group (11%) and 2 in the malignant group (18%). The only patient with recurrence in the benign phyllodes group did not have secure margins and pathology report confirmed transection of the tumour. Conclusions: Benign Phyllodes tumours have a very low rate of recurrence and do not recur when excised completely. Short or long term follow up is not required in this patient cohort but patients with borderline or malignant lesions should remain under review. http://dx.doi.org/10.1016/j.ejso.2015.03.176 P139. A radical approach to the management of radiotherapy induced angiosarcoma of the breast: A combination of wide excision and reconstruction Riffat Aslam, Robert Warner, Samuel Ford, David Gourevitch, Anant Desai, Mike Hallissey Queen Elizabeth Hospital, Birmingham, UK Angiosarcomas are rare tumours of endovascular origin and occur as either primary tumours or more commonly, as secondary tumours following adjuvant radiotherapy for breast cancer. Radiotherapy-associated angiosarcomas are associated with a poor prognosis and are often diagnosed late due to the innocuous nature of the clinical signs, which are similar to post-radiotherapy skin changes in the early stages. Simple mastectomy or local excision has been the preferred surgical management, with or without axillary lymph node clearance. In some studies local recurrence rate is quoted to be as high as 92%, with involved margins at excision associated with poor survival. Over the last 18 months, 7 patients (4 primary excisions and 3 excisions for local failure) with radiation-induced angiosarcomas have undergone radical excision of much of the radiotherapy field in order to gain clearance and minimize local recurrence. In the 4 patients that underwent primary wide excision all had adequately clear margins. Three patients referred after failure of local treatment had previously had a simple mastectomy and marginal clearance with early evidence of recurrent disease. We performed radical resection, including pectoralis musculature, for this subgroup of patients and achieved clear margins in two. The third patient, with two previous marginal excisions, had positive deep margins extending to the chest wall, which ultimately proved unresectable. The mean time from radiotherapy to presentation was 7.4yrs. The average defect size created following wide excision of the angiosarcoma was 550cm and can present reconstructive challenges for this group of patients. Four patients underwent a primary latissimus dorsi flap reconstruction. Three patients had a split skin graft primarily applied to the defect. In our region we currently advocate early referral of radiotherapyinduced angiosarcomas to the specialist sarcoma MDT. We recommend wide excision of the radiotherapy field in order to gain clearance and minimize local recurrence. This surgery should be planned in conjunction with plastic surgeons, as the subsequent defect can be a challenge to reconstruct. http://dx.doi.org/10.1016/j.ejso.2015.03.177 P140. Central round block repair of large breast resection defects: Aesthetic and oncological outcomes R.J.Bramhall, J.Lee,M.Concepcion,D.Westbroek, S.Huf,M.Kabir, P. Thiruchelvam, G.P.H. Gui Royal Marsden Hospital, London, UK Introduction: The central round block repair is a volume displacement technique that can be used to reconstruct large wide local excision (WLE) defects in breasts with moderate ptosis/hypertrophy. This is a modification of the mammaplasty technique described by Benelli where significant volumes can be excised, the skin adjusted and the breast re-coned through a de-epithelialised concentric ring. There are no long-term studies showing the oncologic safety or the aesthetic outcomes of this technique. This study reviews a single institution’s experience. Methods: A review of 57 consecutive patients who underwent central round block repair under the care of a single surgeon with a minimum of 6 months follow-up. All patients had DCIS, stage I/II invasive breast cancer or a phyllodes tumour. Results: Median age was 51 yrs (range 22e86) and follow-up 4 yrs (range 0.6e6.6). Median specimen weight was 50g (range 25e361gm) and tumour size 25mm (10e75mm). Estimated volume of breast excised was 17.8% (6.3e31.1%). 12/57 patients had incomplete margins. 5 had re-excision to achieve clear margins and 7 required mastectomy. There were 3 clinically significant seromas, 3 infections and 2 wound