Breast Angiosarcoma: 15-Years Experience

Breast angiosarcoma is a rare, aggressive malignancy that can be primary (PAS) or secondary (SAS). This study evaluates the management and outcomes of breast angiosarcoma in a single-center breast/surgical oncology unit.

A retrospective review was conducted on patients with histologically confirmed PAS or SAS who underwent surgical resection at Mater Hospital Brisbane between 2009 and 2024. Patient characteristics, clinical features, treatment, complications, and survival outcomes were analyzed.

Fifteen patients were included-4 with PAS and 11 with SAS. SAS patients were significantly older, all had a history of breast cancer treated with adjuvant radiotherapy, and commonly presented with skin discoloration (bruising or violaceous rash). There was a trend toward a shorter duration from presentation to diagnosis and fewer investigations required in PAS patients. Management did not differ between PAS and SAS groups; all patients underwent surgical resection and less than half received adjuvant radiotherapy or chemotherapy. Median follow-up was 27 months for PAS patients and 12 months for SAS patients. The local recurrence rate in the SAS group was 9.1%, with no local recurrence observed in the PAS group (p = 0.53). Mortality rates were 25% in the PAS group and 18.2% in the SAS group (p = 0.77).

Breast angiosarcoma has a poor prognosis with high recurrence and mortality. Diagnosis is difficult due to its rarity, subtle symptoms, and non-specific imaging. Clinicians should maintain a high index of suspicion to facilitate early diagnosis and referral to dedicated sarcoma/breast units for optimal management of this rare malignancy.