74 Abstracts ¨Mandibular intraoseous angiosarcoma, a multidisciplinary approac ¨ h N. Avalos * , R. Chateau, M. Lopez, E. Fumeaux, T. Merino, A. Teare Hospital Fuerza Aérea de Chile, Santiago, Chile Background: The angiosarcoma is a malignant mesenchy- mal cells tumor with a differentiation into vascular endothelium. Angiosarcoma is a rare tumor and can occur in any location of the body, being the most common sites soft tissue and skin. This pathology in the oral cavity is extremely rare, there are a few cases reported and case series described in literature. Objectives: Show a multimodal treatment for a high-grade mandibular sarcoma, with very good long-term survival. Methods: One female patient of 56 years old presented a left mandibular intraosseous angiosarcoma. The confirmation of the entity was made by percutaneous biopsy, and the treatment involved surgery and reconstruction with fibular flap, radiotherapy and chemotherapy with doxorrubicine. The patient underwent a complete resection surgery that involved a fibula reconstruction. The surgery was made in the year 2006, the patient still lives and didn’t have any recurrence. Findings: Multimodal treatment for a high-grade mandibular sarcoma, with very good long-term survival. Conclusion: It’s important to report this extremely rare cases involving the oral cavity; the approach and treatment for this clin- ical case was successful. There is not much information about this entity, and even less in the mandibular intraosseous type. The tech- nique used in the biopsy was essential for the treatment success, and for not spreading the tumor. The multidisciplinary treatment that involved radiotherapy, chemotherapy and respective surgery, with the reconstruction of the site achieved success. The Multi- modal treatment of a high-grade mandibular sarcoma combines multiple disciplines to overcome this pathology with high rates of success. https://doi.org/10.1016/j.ijom.2019.03.221 Referral route patterns for head and neck cancers treated at a single regional unit in 2017 in South East England R. Boyapati * , S. Patel, B. Barrett Queen Victoria Hospital, East Grinstead, UK Background: Two weeks wait referral system was introduced to enable medical and dental practitioners in primary care to urgently refer patients with suspected head and neck cancers. Objectives: To identify the method of referral for patients who were surgically treated for head and neck squamous cell carcinoma at Queen Victoria Hospital, East Grinstead, UK in 2017. Malig- nancies of cutaneous origin were excluded from the data. We also compared the diagnostic yield of 100 referrals between Jan 2017- March 2017. Methods: We retrospectively obtained the route of referral of patients with head and neck cancer who had undergone surgical resection at East Grinstead Hospital, a regional head & neck can- cer center in South East England in 2017. We retrospectively also analyzed 100 patients referred via the two weeks wait pathway between January-March 2017.Data were collected on the propor- tion warranting further investigation in the form of histopathology. Findings: Only 52% of patients of the two week waits required histopathological investigation. Of these, 9% were diagnosed with a malignancy. Other biopsy results largely consisted of keratosis (n = 18), five lichenoid reactions and 14 other benign inflammatory lesions. 55% were referred from medical practitioner’s whist 45% were referred from dentists. Only 49% patients who were oper- ated for head and neck cancers in 2017 were referred urgently by doctors and dentists. Conclusion: It is reasonable to conclude that, at present, the two weeks wait system should continue to ensure there is no barrier to urgent referral for primary care medical and dental professionals as 49% of cancers operated by head and neck cancer teams are from them. More guidance is required to evaluate the oral lesions effectively in the primary care setting for the referral process to be robust. https://doi.org/10.1016/j.ijom.2019.03.222 Diffusion tensor imaging (DTI) in head and neck oncology; a new method of virtual Biopsy A. Calvo * , L. Catalfamo, M. Runci Anastasi, M. Sergiampietri, D. Milardi, G. Anastasi, F.S. De Ponte University of Messina, Messina, Italy Background: Diffusion Tensor Imaging (DTI) in Head and Neck Oncology Objectives: The objective of our study is to explore the fea- sibility and utility of Diffusion Tensor Imaging (DTI) in the non invasive evaluation of any lesion [1] in Head and Neck structure. We would reach a verified and certified step of Virtual biopsy. Methods: Twenty patients with different histological lesions were recruited for this study. Morphological and diffusion weighted images were acquired with a 3T scanner during last 3 months. Probabilistic tensor-based tractography reconstruction of any lesions was performed and mean fractional anisotropy (FA) values for everyone were extracted [2]. Findings: The results showed that the Diffusion Tensor Imag- ing (DTI) was able to identify the lesion geometrical morphology and diffusion microstructural changes. The patient with a benign lesion reported a significant improvement in ADC mean values. Conclusion: We have evidence that pushes us to continue with this method. We are at the beginning of this work. We had to recruits more patients to get meaningfully significant data. References Haradome, H., Grazioli, L., Morone, M., Gambarini, S., Kwee, T. C., Taka- hara, T., & Colagrande, S. (2012). T2-weighted and diffusion-weighted MRI for discriminating benign from malignant focal liver lesions: diag- nostic abilities of single versus combined interpretations. J Magn Reson Imaging, 35, 1388–1396. Chilla, G. S., Tan, C. H., Xu, C., & Poh, C. L. (2015). Diffusion weighted magnetic resonance imaging and its recent trend—a survey. Quant Imag- ing Med Surg, 5(3), 407–422, doi: 10.3978/j.issn.2223-4292.2015.03.01. https://doi.org/10.1016/j.ijom.2019.03.223