Abstract
Angiosarcomas of the breast (ASB) are rare, making up to less than 8% of all angiosarcomas. The surgical management for this disease continues to vary throughout centres worldwide due to the current limited evidence. We aim to examine the necessity of axillary lymph node dissection in this pathology through a retrospective study of axillary metastasis and recurrence patterns in patients treated at our institution. A retrospective review of a prospectively-maintained database was performed. All adult patients with a histologically confirmed diagnosis of ASB seen at the National Cancer Centre Singapore between 2006 and 2019 were identified. Axillary lymph node status, treatment, survival, and recurrence data were collated. Thirteen patients were identified with a confirmed diagnosis of ASB, of which there were 11 primary and 2 secondary angiosarcoma cases. Eight patients had some form of axillary lymph node dissection and 5 did not. No positive nodes were found in any examined axillary nodes despite high median number of nodes harvested (13, range 8–24). 5/13 patients had disease progression, of whom none had locoregional recurrence to the axilla. ASB continues to be rare and recurrent and presents as a challenge to treat. Axillary lymph node involvement is most likely not present in a majority of patients. Prophylactic removal is unwarranted in patients presenting without lymph node involvement due to the lack of axillary metastasis.
Highlights
Angiosarcomas are malignancies arising from the endothelium of vascular channels [1]. ey are a substantially rare subtype of sarcoma and make up to less than 1% of all sarcoma cases [1,2,3]
They have the potential to present anywhere in the body [2], they infrequently appear in the soft tissue of the breast, with angiosarcomas of the breast (ASB) estimated to form only about 8% [4] of all angiosarcomas
In our clinical audit where axillary node sampling and dissection were performed, we noted the absence of involved nodes. e median number of nodes harvested amongst these patients was high (13, range: 8–24) reflecting that the lack of positive nodes was not due to poor lymph node harvest during axillary dissection
Summary
Angiosarcomas are malignancies arising from the endothelium of vascular channels [1]. ey are a substantially rare subtype of sarcoma and make up to less than 1% of all sarcoma cases [1,2,3]. Ey are a substantially rare subtype of sarcoma and make up to less than 1% of all sarcoma cases [1,2,3] They have the potential to present anywhere in the body [2], they infrequently appear in the soft tissue of the breast, with angiosarcomas of the breast (ASB) estimated to form only about 8% [4] of all angiosarcomas. Several authors have reported data on ALND, but these studies [3, 10,11,12, 14, 16, 20] are limited in that there is a lack in one or more of the following: analysis of the role of ALND as a prognostic factor, data on angiosarcomas specific to the breast tissue, sufficient patient numbers, or complete ALND data for all patients
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