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Can metastases be predicted in breast cancer patients with local recurrence?
1234
ABSTRACTS
Introduction: Oxidative stress has been implicated as a contributory factor in the development of breast cancer. Reactive oxygen species can initiate lipid peroxidation, the reactive secondary products of which can induce oxidative DNA damage and mutations in the p53 tumour suppressor gene. We have correlated the levels of lipid peroxdation products; malondialdehyde and 8-iso-Prostaglandin F2a (8-iso-PGF2a), in patients with primary breast cancer with known prognostic factors such as ER-status, HER2 status and stage and grade of the tumour. Methods: 89 patients with primary operable breast cancer and 10 healthy subjects were studied. Plasma levels of MDA (total and free) and 8-iso-PGF2a were measured. Results: The majority of patients were over 50 (87%), had grade II/III tumours (68%), were axillary lymph node positive (41%) and had ER-positive tumours (82%). Compared to the control, patients had higher levels of total MDA (p < 0.001), free MDA (p < 0.001), and 8-iso-PGF2a (p < 0.001). Total MDA was significantly correlated with increasing grade (p ¼ 0.001), tumour size (p < 0.05), ER negativity (p < 0.05) and higher NPI (p < 0.001). Furthermore, free MDA showed statistically significant correlations with both grade (p <0.05) and NPI (p <0.05). 8-iso-PGF2a showed only a correlation with increasing age. (p < 0.05). Conclusion: The present study shows that patients with breast cancer have evidence of increased oxidative stress. Furthermore, MDA concentration was associated with conventional markers of poor prognosis suggesting involvement in tumour progression. MDA maybe a useful marker of tumour associated oxidative damage and may provide a promising marker for risk prediction and targets for preventative measures in breast cancer patients. P110. Does sentinel node biopsy or the timing of completion axillary clearance alter the axillary nodal harvest in breast cancer surgery? Ben Byrnea, R. Cutressb, J. Gilla, M. Wisea, C. Yiangoua, A. Agrawala a Portsmouth Hospitals NHS Trust, Royal Hospital Haslar, Haslar Road, Gosport, PO12 2AA b Southampton Hospitals NHS Trust Introduction: Patients with a positive sentinel node biopsy (SNB) may undergo delayed completion axillary dissection (dALND) which is arguably technically more demanding then axillary dissection without SNB. Where intra-operative analysis is available, immediate completion axillary dissection (iALND) can be performed. It is not known if there is a difference in the total number of lymph nodes or the number of metastatic nodes harvested between the 3 possible approaches. Methods: Three groups of 50 consecutive patients who underwent axillary dissection without SNB, SLNB and dALND, and SNB with iALND were identified from the Portsmouth Breast Unit Database. Patient demographics, clinico-pathological variables and surgical treatment were documented. The total pathological nodal count and the number of metastatic nodes were compared between the groups. Results: The mean nodal harvest following axillary dissection without SNB was 13.2 (95% Confidence interval (CI): 11.2e15.1), whilst following SNB with dALND it was 15.0 (CI 13.1e16.9) and following SNB with iALND it was 14.4 (CI: 12.3e15.9). Differences between the 3 groups were not statistically significant. The mean number of metastatic nodes harvested following SNB with dALND was 3.3 (CI: 2.2e4.4) and following SNB with iALND was 3.3 (CI: 2.2e4.4).
Conclusion: Immediate ALND has many advantages without compromising total nodal yield or number of metastatic nodes retrieved. P111. Core biopsy is mandatory for the evaluation of ultrasoundindeterminate (U3) breast lesions. Mahesh Kudari, K. Naeem, C. Chianakwalam William Harvey Hospital, Kennington Road, Ashford, Kent, TN24 0LZ Introduction: There is an increasing detection of indeterminate lesions on breast ultrasound. The aim of this study was to evaluate the pathological features of these lesions and determine their yield of malignant histology. Methods: The radiology database was retrospectively reviewed for all ultrasound detected indeterminate lesions coded U3 between September 2007 and April 2008. These lesions were all subjected to ultrasoundguided core biopsies except one which was assessed by image-guided excisional biopsy. The subsequent histology results were evaluated. Results: Of 62 U3 lesions, 6 (9.7%) proved to be malignant lesions invasive ductal carcinoma (3), ductal carcinoma in situ (1), sarcoma (1) and malignant spindle cell tumour (1). There were 56 benign lesions of which 18 (29%) were fibroadenomas. The rest were fibrocystic (9), lymph node (3), radial scar (2), papilloma(2), phylloides tumour (1), lipoma (1), hamartoma (1). There were 19 unclassified benign lesions including fibrofatty tissue related to previous surgery and/or radiotherapy. Conclusion: A significant number of ultrasound-indeterminate breast lesions are malignant and therefore warrant a core biopsy for definitive diagnosis. P112. Can metastases be predicted in breast cancer patients with local recurrence? Jonathan Fortunea, C. Griffithb, A. Griffithsb, R. Blissb, T. Lennardb a Newcastle University Medical School, Framlington Place, Newcastle upon Tyne, NE24HH b Royal Victoria Infirmary Introduction: Breast cancer treatment aims to achieve cure if possible or to reduce the risk of local and distant recurrence to the minimum. In patients treated for primary breast cancer who develop locoregional recurrence some will have true localised recurrence whereas in other patients it is a sign of synchronous distant metastatic disease. The aim of this study was to attempt to identify factors that predict for true local versus local plus distant recurrence. Methods: Patients presenting with locoregional recurrence over a three year period were identified from the RVI database. This population was split into groups based on presence or absence of distant metastases. An analysis of tumour parameters in the groups was performed using Student’s unpaired t-test as a measure of statistical significance. Results: 70 patients presented with breast cancer recurrence. The patients with localised recurrences and metastases (n ¼ 15) had on average 14 mm larger primary tumours (p ¼ 0.016), 37.3 months shorter disease free interval (p ¼ 0.105) and 17.5% more grade 3 tumours (p ¼ 0.751) than the recurrences without metastatic disease (n ¼ 55) (Table 1). Conclusions: This small study demonstrates clear trends between the biology of the primary tumour and recurrence associated with metastatic
Table 1 Locoregional Recurrences
Disease Free Interval (months) Primary Tumour Size (mm) Grade 1 Tumour (%) Grade 2 Tumour (%) Grade 3 Tumour (%)
Local Recurrences
Without Metastases
With Metastases
True Local
Local With Metastases
N
mean/freq
n
mean/freq
P value
n
mean/freq
n
mean/freq
P value
55 24 42 42 42
133.4 10.8 22 1.7 14.3 47.6 38.1
15 7 9 9 9
96.1 17.9 36 9.2 11.1 33.3 55.6
0.105 0.016 0.627 0.232 0.751
35 15 28 28 28
116.3 11.8 21.7 2.4 17.9 42.9 39.2
6 4 5 5 5
88.5 32.3 29 7.2 0 60 40
0.381 0.225 0.323 0.460 0.926
ABSTRACTS disease which should help to identify patients to be treated with the highest index of clinical suspicion. A current analysis to measure the annual recurrence rate of the breast unit will form a suitable cohort for large scale prospective study of the parameters compared here, and as previously demonstrated with primary breast cancers, could lead to improved guidelines on how best to stage at recurrence.
P113. Are hospital trusts losing income by incomplete coding of operations? A review of complex breast surgery in a tertiary breast unit Tracey Irvine, S. Kalipershad, A. Baildam Nightingale Centre and Christie Hospital, Wythenshawe Hospital, Southmoor Road, Manchester, M23 9LT Background: In these difficult financial times it is important that Trusts get paid for the operations surgeons perform. Surgeons are rarely involved in the coding process and this may lead to inaccuracies and thus underpayment. This study aimed to assess the accuracy of data recorded about theatre activity and explore the financial implications of inaccurate coding. Methods: This was a retrospective case note review of all patients operated on by a single surgeon in a 3 month period. The operation note was taken to be gold standard and this was compared with the operating diary, theatre data, coding department data and financial data. Financial implications of inaccurate coding were also explored. Results: 66 patients had operations in the study period, often having more than one procedure. 87.7% had the operation that was planned. 21.5% of operations were missing from the theatre data and only 58.5% were accurately recorded. 31.2% of codes were incorrect compared to operation note. 23.7% of operation notes contained more information than was immediately apparent. Some of the more modern procedures did not have OPCS codes. Conclusions: Although the coding department worked hard to obtain accurate data the complexity of cases was not reflected. Routine cases are documented badly and complex cases are difficult to code which has financial and resource implications. Surgeons need to understand these issues and take responsibility for ensuring the work they have done is coded accurately to guarantee appropriate payment.
P114. Ipsilateral breast tumour recurrence - is mastectomy the only option? Tracey Irvine, H. Lane, M. Kissin Royal Surrey County Hospital, Guildford, Egerton Road, Guildford, GU2 7XX Background: Patients who develop ipsilateral breast tumour recurrence (IBTR) after breast conserving surgery have traditionally been offered salvage mastectomy. In Guildford breast conserving surgery is offered as an option for these patients if feasible. There is little evidence in the literature on the outcome of these patients. Methods: All patients who had further local surgery for IBTR after failed breast conservation by a single surgeon from January 1994 to December 2006 were studied. This allowed for a minimum two year follow up. Endpoints were disease free survival and overall survival. Results: 114 patients were eligible for inclusion. 48 underwent further breast conserving surgery and 66 underwent a mastectomy for their first ipsilateral relapse. The median follow up period was 66 months. There was no statistically significant difference in disease free survival or overall survival between the two groups. Conclusions: There is no evidence from this study to suggest that mastectomy is the only option for patients who fail breast conservation. In selected patients a second attempt at breast conservation may be feasible. Larger studies may be needed to investigate this further.
1235 P115. Factors influencing implementation of decisions made within a multi-disciplinary breast team Rachel Englisha, J. Blazebyb, C. Metcalfec, Z. Wintersa, Z. Raytera, J. Dayb a University Hospitals Bristol NHS Foundation Trust, Bristol, Upper Maudlin Street, Bristol, BS2 8AE b Division of Surgery, Head & Neck, University of Bristol c University of Bristol Introduction: In the UK it is mandatory for clinical decisions concerning patients with known or suspected breast cancer to be made within the context of a multi-disciplinary team (MDT). However, MDT efficiency and whether MDT decisions are implemented is unknown. Evidence suggests that decisions may change after the meeting which could reflect an inefficient process. This study investigated the implementation rates of MDT treatment decisions and examined factors associated with changed decisions. Methods: Consecutive MDT decisions, subsequent treatment implementation and basic patient details were prospectively recorded from specialist breast MDT meetings. When MDT decisions were not implemented, the case was examined in detail. Results: 299 consecutive treatment decisions concerning 213 patients were analysed. Twenty-two decisions (7.4%, 95% CI 4.7% to 10.9%) were not implemented. Non-implementation was due to patient choice (n ¼ 14, 63%), discovery of new clinical information following the MDT discussion (n ¼ 4, 18%) or individual doctors changing the MDT plan (n ¼ 4, 18%). MDT decisions were significantly more likely to change in patients with confirmed malignant disease compared to those with benign or ‘unknown’ disease categories (p < 0.001). A significant trend was also noted for non-implementation of MDT recommendations in patients with increasing age (p < 0.006). Conclusions: Clinical decisions made within the context of a specialist breast MDT are usually implemented. The main reason for changes in treatment is related to patient choice. Decisions change more frequently in older patients and those with proven malignancy. Further work is needed to develop ways of including patient related factors into team decision-making. P116. The increase in B3/B4 biopsies following the introduction of the mammotome for diagnosing breast lesions Hazem Khout, R. Veeratterapillay, K. Clark Queen Elizabeth Hospital, Department of Surgery, Sherif Hill, Gateshead, NE9 6SX Introduction: To evaluate the effect of introducing the mammotome on the number of indeterminate breast biopsy results (B3 /B4) and the subsequent impact on the number of surgical guide wire biopsies. Methods: A retrospective review of cases with indeterminate core biopsies results B3 (most likely benign) and B4 (suspicious) were conducted in the period 2002-2003 (pre - mammotome) and 2004 - 2007 (post mammotome) at our institution. Results: In total, 264 patients had indeterminate core biopsy result during the period from 2002-2007 (70 were B4 and 194 were B3). All of these patients underwent guide wire biopsy to confirm the diagnosis. In the pre -mammotome period 54 patients had B3/B4 result (27 patients/year).On the other hand, 210 patients had B3/B4 result in the post - mammotome period (52.5 patients/year). There was therefore a 94% increase in B3/ B4 biopsies following the introduction of the mammotome. B3 2002 12 2003 22 Introduction of mammotome 2004 28 2005 38 2006 61 2007 33
B4
Total
4 16
16 38
21 7 15 7
49 45 76 40
ABSTRACTS
Introduction: Oxidative stress has been implicated as a contributory factor in the development of breast cancer. Reactive oxygen species can initiate lipid peroxidation, the reactive secondary products of which can induce oxidative DNA damage and mutations in the p53 tumour suppressor gene. We have correlated the levels of lipid peroxdation products; malondialdehyde and 8-iso-Prostaglandin F2a (8-iso-PGF2a), in patients with primary breast cancer with known prognostic factors such as ER-status, HER2 status and stage and grade of the tumour. Methods: 89 patients with primary operable breast cancer and 10 healthy subjects were studied. Plasma levels of MDA (total and free) and 8-iso-PGF2a were measured. Results: The majority of patients were over 50 (87%), had grade II/III tumours (68%), were axillary lymph node positive (41%) and had ER-positive tumours (82%). Compared to the control, patients had higher levels of total MDA (p < 0.001), free MDA (p < 0.001), and 8-iso-PGF2a (p < 0.001). Total MDA was significantly correlated with increasing grade (p ¼ 0.001), tumour size (p < 0.05), ER negativity (p < 0.05) and higher NPI (p < 0.001). Furthermore, free MDA showed statistically significant correlations with both grade (p <0.05) and NPI (p <0.05). 8-iso-PGF2a showed only a correlation with increasing age. (p < 0.05). Conclusion: The present study shows that patients with breast cancer have evidence of increased oxidative stress. Furthermore, MDA concentration was associated with conventional markers of poor prognosis suggesting involvement in tumour progression. MDA maybe a useful marker of tumour associated oxidative damage and may provide a promising marker for risk prediction and targets for preventative measures in breast cancer patients. P110. Does sentinel node biopsy or the timing of completion axillary clearance alter the axillary nodal harvest in breast cancer surgery? Ben Byrnea, R. Cutressb, J. Gilla, M. Wisea, C. Yiangoua, A. Agrawala a Portsmouth Hospitals NHS Trust, Royal Hospital Haslar, Haslar Road, Gosport, PO12 2AA b Southampton Hospitals NHS Trust Introduction: Patients with a positive sentinel node biopsy (SNB) may undergo delayed completion axillary dissection (dALND) which is arguably technically more demanding then axillary dissection without SNB. Where intra-operative analysis is available, immediate completion axillary dissection (iALND) can be performed. It is not known if there is a difference in the total number of lymph nodes or the number of metastatic nodes harvested between the 3 possible approaches. Methods: Three groups of 50 consecutive patients who underwent axillary dissection without SNB, SLNB and dALND, and SNB with iALND were identified from the Portsmouth Breast Unit Database. Patient demographics, clinico-pathological variables and surgical treatment were documented. The total pathological nodal count and the number of metastatic nodes were compared between the groups. Results: The mean nodal harvest following axillary dissection without SNB was 13.2 (95% Confidence interval (CI): 11.2e15.1), whilst following SNB with dALND it was 15.0 (CI 13.1e16.9) and following SNB with iALND it was 14.4 (CI: 12.3e15.9). Differences between the 3 groups were not statistically significant. The mean number of metastatic nodes harvested following SNB with dALND was 3.3 (CI: 2.2e4.4) and following SNB with iALND was 3.3 (CI: 2.2e4.4).
Conclusion: Immediate ALND has many advantages without compromising total nodal yield or number of metastatic nodes retrieved. P111. Core biopsy is mandatory for the evaluation of ultrasoundindeterminate (U3) breast lesions. Mahesh Kudari, K. Naeem, C. Chianakwalam William Harvey Hospital, Kennington Road, Ashford, Kent, TN24 0LZ Introduction: There is an increasing detection of indeterminate lesions on breast ultrasound. The aim of this study was to evaluate the pathological features of these lesions and determine their yield of malignant histology. Methods: The radiology database was retrospectively reviewed for all ultrasound detected indeterminate lesions coded U3 between September 2007 and April 2008. These lesions were all subjected to ultrasoundguided core biopsies except one which was assessed by image-guided excisional biopsy. The subsequent histology results were evaluated. Results: Of 62 U3 lesions, 6 (9.7%) proved to be malignant lesions invasive ductal carcinoma (3), ductal carcinoma in situ (1), sarcoma (1) and malignant spindle cell tumour (1). There were 56 benign lesions of which 18 (29%) were fibroadenomas. The rest were fibrocystic (9), lymph node (3), radial scar (2), papilloma(2), phylloides tumour (1), lipoma (1), hamartoma (1). There were 19 unclassified benign lesions including fibrofatty tissue related to previous surgery and/or radiotherapy. Conclusion: A significant number of ultrasound-indeterminate breast lesions are malignant and therefore warrant a core biopsy for definitive diagnosis. P112. Can metastases be predicted in breast cancer patients with local recurrence? Jonathan Fortunea, C. Griffithb, A. Griffithsb, R. Blissb, T. Lennardb a Newcastle University Medical School, Framlington Place, Newcastle upon Tyne, NE24HH b Royal Victoria Infirmary Introduction: Breast cancer treatment aims to achieve cure if possible or to reduce the risk of local and distant recurrence to the minimum. In patients treated for primary breast cancer who develop locoregional recurrence some will have true localised recurrence whereas in other patients it is a sign of synchronous distant metastatic disease. The aim of this study was to attempt to identify factors that predict for true local versus local plus distant recurrence. Methods: Patients presenting with locoregional recurrence over a three year period were identified from the RVI database. This population was split into groups based on presence or absence of distant metastases. An analysis of tumour parameters in the groups was performed using Student’s unpaired t-test as a measure of statistical significance. Results: 70 patients presented with breast cancer recurrence. The patients with localised recurrences and metastases (n ¼ 15) had on average 14 mm larger primary tumours (p ¼ 0.016), 37.3 months shorter disease free interval (p ¼ 0.105) and 17.5% more grade 3 tumours (p ¼ 0.751) than the recurrences without metastatic disease (n ¼ 55) (Table 1). Conclusions: This small study demonstrates clear trends between the biology of the primary tumour and recurrence associated with metastatic
Table 1 Locoregional Recurrences
Disease Free Interval (months) Primary Tumour Size (mm) Grade 1 Tumour (%) Grade 2 Tumour (%) Grade 3 Tumour (%)
Local Recurrences
Without Metastases
With Metastases
True Local
Local With Metastases
N
mean/freq
n
mean/freq
P value
n
mean/freq
n
mean/freq
P value
55 24 42 42 42
133.4 10.8 22 1.7 14.3 47.6 38.1
15 7 9 9 9
96.1 17.9 36 9.2 11.1 33.3 55.6
0.105 0.016 0.627 0.232 0.751
35 15 28 28 28
116.3 11.8 21.7 2.4 17.9 42.9 39.2
6 4 5 5 5
88.5 32.3 29 7.2 0 60 40
0.381 0.225 0.323 0.460 0.926
ABSTRACTS disease which should help to identify patients to be treated with the highest index of clinical suspicion. A current analysis to measure the annual recurrence rate of the breast unit will form a suitable cohort for large scale prospective study of the parameters compared here, and as previously demonstrated with primary breast cancers, could lead to improved guidelines on how best to stage at recurrence.
P113. Are hospital trusts losing income by incomplete coding of operations? A review of complex breast surgery in a tertiary breast unit Tracey Irvine, S. Kalipershad, A. Baildam Nightingale Centre and Christie Hospital, Wythenshawe Hospital, Southmoor Road, Manchester, M23 9LT Background: In these difficult financial times it is important that Trusts get paid for the operations surgeons perform. Surgeons are rarely involved in the coding process and this may lead to inaccuracies and thus underpayment. This study aimed to assess the accuracy of data recorded about theatre activity and explore the financial implications of inaccurate coding. Methods: This was a retrospective case note review of all patients operated on by a single surgeon in a 3 month period. The operation note was taken to be gold standard and this was compared with the operating diary, theatre data, coding department data and financial data. Financial implications of inaccurate coding were also explored. Results: 66 patients had operations in the study period, often having more than one procedure. 87.7% had the operation that was planned. 21.5% of operations were missing from the theatre data and only 58.5% were accurately recorded. 31.2% of codes were incorrect compared to operation note. 23.7% of operation notes contained more information than was immediately apparent. Some of the more modern procedures did not have OPCS codes. Conclusions: Although the coding department worked hard to obtain accurate data the complexity of cases was not reflected. Routine cases are documented badly and complex cases are difficult to code which has financial and resource implications. Surgeons need to understand these issues and take responsibility for ensuring the work they have done is coded accurately to guarantee appropriate payment.
P114. Ipsilateral breast tumour recurrence - is mastectomy the only option? Tracey Irvine, H. Lane, M. Kissin Royal Surrey County Hospital, Guildford, Egerton Road, Guildford, GU2 7XX Background: Patients who develop ipsilateral breast tumour recurrence (IBTR) after breast conserving surgery have traditionally been offered salvage mastectomy. In Guildford breast conserving surgery is offered as an option for these patients if feasible. There is little evidence in the literature on the outcome of these patients. Methods: All patients who had further local surgery for IBTR after failed breast conservation by a single surgeon from January 1994 to December 2006 were studied. This allowed for a minimum two year follow up. Endpoints were disease free survival and overall survival. Results: 114 patients were eligible for inclusion. 48 underwent further breast conserving surgery and 66 underwent a mastectomy for their first ipsilateral relapse. The median follow up period was 66 months. There was no statistically significant difference in disease free survival or overall survival between the two groups. Conclusions: There is no evidence from this study to suggest that mastectomy is the only option for patients who fail breast conservation. In selected patients a second attempt at breast conservation may be feasible. Larger studies may be needed to investigate this further.
1235 P115. Factors influencing implementation of decisions made within a multi-disciplinary breast team Rachel Englisha, J. Blazebyb, C. Metcalfec, Z. Wintersa, Z. Raytera, J. Dayb a University Hospitals Bristol NHS Foundation Trust, Bristol, Upper Maudlin Street, Bristol, BS2 8AE b Division of Surgery, Head & Neck, University of Bristol c University of Bristol Introduction: In the UK it is mandatory for clinical decisions concerning patients with known or suspected breast cancer to be made within the context of a multi-disciplinary team (MDT). However, MDT efficiency and whether MDT decisions are implemented is unknown. Evidence suggests that decisions may change after the meeting which could reflect an inefficient process. This study investigated the implementation rates of MDT treatment decisions and examined factors associated with changed decisions. Methods: Consecutive MDT decisions, subsequent treatment implementation and basic patient details were prospectively recorded from specialist breast MDT meetings. When MDT decisions were not implemented, the case was examined in detail. Results: 299 consecutive treatment decisions concerning 213 patients were analysed. Twenty-two decisions (7.4%, 95% CI 4.7% to 10.9%) were not implemented. Non-implementation was due to patient choice (n ¼ 14, 63%), discovery of new clinical information following the MDT discussion (n ¼ 4, 18%) or individual doctors changing the MDT plan (n ¼ 4, 18%). MDT decisions were significantly more likely to change in patients with confirmed malignant disease compared to those with benign or ‘unknown’ disease categories (p < 0.001). A significant trend was also noted for non-implementation of MDT recommendations in patients with increasing age (p < 0.006). Conclusions: Clinical decisions made within the context of a specialist breast MDT are usually implemented. The main reason for changes in treatment is related to patient choice. Decisions change more frequently in older patients and those with proven malignancy. Further work is needed to develop ways of including patient related factors into team decision-making. P116. The increase in B3/B4 biopsies following the introduction of the mammotome for diagnosing breast lesions Hazem Khout, R. Veeratterapillay, K. Clark Queen Elizabeth Hospital, Department of Surgery, Sherif Hill, Gateshead, NE9 6SX Introduction: To evaluate the effect of introducing the mammotome on the number of indeterminate breast biopsy results (B3 /B4) and the subsequent impact on the number of surgical guide wire biopsies. Methods: A retrospective review of cases with indeterminate core biopsies results B3 (most likely benign) and B4 (suspicious) were conducted in the period 2002-2003 (pre - mammotome) and 2004 - 2007 (post mammotome) at our institution. Results: In total, 264 patients had indeterminate core biopsy result during the period from 2002-2007 (70 were B4 and 194 were B3). All of these patients underwent guide wire biopsy to confirm the diagnosis. In the pre -mammotome period 54 patients had B3/B4 result (27 patients/year).On the other hand, 210 patients had B3/B4 result in the post - mammotome period (52.5 patients/year). There was therefore a 94% increase in B3/ B4 biopsies following the introduction of the mammotome. B3 2002 12 2003 22 Introduction of mammotome 2004 28 2005 38 2006 61 2007 33
B4
Total
4 16
16 38
21 7 15 7
49 45 76 40