A need for clarity on Surgical Management of Breast Sarcoma: Scottish Sarcoma Network Guidelines and Regional Audit

Abstract Currently there are no comprehensive breast sarcoma guidelines in the UK. There is therefore a need for guidelines to clarify surgical management, which we have based on data from our regional audit, current evidence, and consensus between West of Scotland Breast Cancer and Scottish Sarcoma Managed Clinical Networks. Methods and Results:46 patients were treated with breast sarcoma in the West of Scotland from 2007 to 2019. Sarcoma Centre versus Peripheral Hospitals: Incomplete excision rate was 0% at sarcoma centre, and 50% at peripheral hospitals (p=0.0002, Odds Ratio 43). For angiosarcoma, 0% positive margin at sarcoma centre versus 62.5% at peripheral unit (p=0.0036, Odds ratio 39.3). Tumours treated at sarcoma centre were larger than peripheral hospitals (92.5 versus 39.7mm, p=0.0009). WLE versus mastectomy: 7/8 (87.5%) WLE had positive margins, with 6 of these patients proceeding to mastectomy (i.e. 75% WLE patients ultimately had a mastectomy). Positive margin rate was significantly higher in WLE (87.5%) than mastectomy (10.3%) (p=0.0001, Odds ratio 60.7). Survival: No difference noted between Sarcoma Centre and Peripheral hospital for overall survival (p=0.43), stratified for tumours Conclusions: Our data strongly suggest that specific guidelines are needed for breast sarcoma, and that managing these patients according to breast carcinoma protocols in peripheral hospitals is sub-optimal. We recommend centralisation of breast sarcoma patient care to a specialist sarcoma centre, with WLE not recommended as a firstline surgical option given both the high rates of incomplete excision and subsequent need for completion mastectomy.