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Is sentinel node biopsy necessary in patients undergoing mastectomy for DCIS?
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ABSTRACTS
(3.2%) had metastases on ANC. 41/72 patients had macrometastases micrometastases on OSNA, and 17/41 (41.4%) had metastases on ANC. On comparison with national data, we had a higher proportion of micrometastases. We also compared the result to a previous study carried out here prior to the introduction of OSNA, and SLNB positivity has increased from 21% to 46.4%. Conclusions: There has been a marked increase in SLNB positivity, and the rate is higher in Liverpool than in the UK overall. There is a high rate of ANC positivity if macrometastases are found on OSNA and a very low rate if only micrometastases are found. http://dx.doi.org/10.1016/j.ejso.2014.02.094
P095. Is sentinel node biopsy necessary in patients undergoing mastectomy for DCIS? Anna Conway, Christopher Rustom, Rosemary Wills, Adrian Ball, Adam Stacey-Clear, Shamaela Waheed Surrey and Sussex Healthcare NHS Trust, Redhill, UK Introduction: NICE guidance recommends patients have sentinel node biopsy (SNB) if they are having mastectomy for ductal carcinoma in situ (DCIS)1. DCIS requiring mastectomy undergo SNB as an invasive component may be identified on final histology and cannot be performed once the breast is removed. The aim of this study was to review the histology of mastectomy specimens and the number upstaged to invasive disease. The number of positive sentinel nodes following SNB was also recorded. Method: The Somerset cancer database was searched to identify these patients treated over a four year period. Data collected included core biopsy, final histology, size of DCIS and/or invasive component, SNB and subsequent axillary clearance results. Results: Thirty-two patients had a mastectomy for DCIS. Nine (28.1%) had an invasive component. 93.8% (30) had negative SNB, 7 of these patients had an invasive component (1 grade 1, 6 grade 2). Mean size of DCIS 42.8mm. Mean size of invasive component 29mm. Two patients had positive SNBs (2/8 and 1/16 after clearance). Both had grade 3 invasive disease. Conclusion: SNB for pure DCIS is controversial but cannot be performed after mastectomy. Other studies have identified 0%2 to 12%3 positive SLNs in patients with DCIS. Despite small sample size, this study supports the use of SNB in patients undergoing mastectomy due to the upstaging to invasive disease. References [1] NICE Guidelines. CG80 Early and locally advanced breast cancer: Diagnosis and treatment. September 2010. [2] Farkas E.A, Stolier A.J, Teng S.C, Bolton J.S, Fuhrman G.M. An argument against routine sentinel node mapping for DCIS. Am Surg. 2004, 70:13-18 [3] Klauber-De More N, et al. Sentinel lymph node biopsy: is it indicated in patients with high-risk ductal carcinoma-in-situ and ductal carcinoma in situ with microinvasion? Ann Surg Oncol 2000, 7:636-642. http://dx.doi.org/10.1016/j.ejso.2014.02.095
P096. A review of the assessment of male breast patients, with special reference to the use of imaging with digital breast tomosynthesis (DBT) and sonography Shazad Khaliq, Anita Maria Huws, T. Ifan Patchell, Kanwaljit Dhande, Saira Khawaja, Khaldoun Nadi, Yousef Sharaiha, Simon Holt Prince Philip Hospital, Llanelli, UK Background: With the increase trend in gym use and the widespread use of protein-shakes and muscle bulking enhancements, the number of referrals of men with ‘breast lumps’ has increased. In addition statins are now widely
prescribed and this also has resulted in a surge of referrals to the male breast clinic. A review of the benefit of imaging and intervention was undertaken to assess whether resources are being utilised effectively. Methods: A retrospective review identified 132 male patients seen within a 2 year period. The following data was collected; age, patient history, presenting symptom, drug history, investigations, imaging, biopsy results, follow-up and management plan. The data was analysed and recorded. Results: 132 consecutive patients identified with an age range of 16 to 84 years, with a small peak at 20-30 years of age and then the largest peak at 60-69 years (25% of the cohort fell within this group). The commonest presenting symptom was a lump (64%), while 22% presented with tender swelling. 77.27% (102/132) had DBT performed, of which 6.86% (7/102 were indeterminate or malignant). Of the 7 abnormal mammograms (age range 49-84), 4 were biopsied and confirmed gynaecomastia, 2 represented invasive ductal carcinoma and 1 intracystic papillary carcinoma. There were 4 cancers (3.03%) in the total cohort, a metastatic deposit in the breast from a renal cell carcinoma was mammographically occult. 100% of the cohort were imaged sonographically. 71.97% (95/132) were diagnosed with gynaecomastia. 58.33% were discharged. Blood tests were requested on the whole cohort and 16.67% (22/132) had abnormal results, 10 of which required further follow-up or tertiary referral to endocrinology. 3.8% (5/132) had surgical treatment for gynaecomastia. Conclusions: Sonography and clinical examination appeared to be more sensitive than mammography in this cohort of patients. This coupled with our findings that indeterminate imaging was more prevalent over 50 may indicate that mammography may be more sensitive in men over 50. http://dx.doi.org/10.1016/j.ejso.2014.02.096
P097. Does therapeutic mammoplasty reduce demand for mastectomy & immediate reconstruction? Jennifer Pollard1, Pang Wong1, James Mansell2, Juliette Murray1, Alison Lannigan1, Julie Doughty2, Laszlo Romics3, Sheila Stallard2, Christopher Wilson2 1 NHS Lanarkshire, Lanarkshire, UK 2 Western Infirmary, Glasgow, UK 3 Victoria Infirmary, Glasgow, UK Introduction: Therapeutic mammoplasty (TM) is increasing in popularity as a method for enhancing breast conserving surgery. Studies have shown it is oncologically safe, whilst improving cosmetic outcome. TM has been gaining popularity in West of Scotland over the past five years. Initially it was thought this may reduce requirement for mastectomy and immediate reconstruction. We have recorded type of surgery patients would have required had they not been suitable for TM, looking at changing demographic of surgical workload. Methods: Prospective data collected about patients undergoing TM in West of Scotland since 2011 in Victoria Infirmary, Western Infirmary and in Lanarkshire. We reviewed clinical indications for TM, surgical alternative, Body Mass Index (BMI) and smoker status. Results: 79 patients were identified. In 67 cases, alternative surgical option of mastectomy or standard conservation was recorded. Mean BMI was 29. 41% of patients had contralateral surgery for symmetry at the same time. In 28 cases (35%) TM avoided need for mastectomy. In 39 cases (49%) it was felt that cosmetic result would be improved by TM compared with standard conservation. During the study period, rates of mastectomy with immediate reconstruction as a proportion of total number of treated cancers have remained similar. Conclusions: Whilst introduction of TM in our region has improved options offered to patients and likely cosmetic outcomes, it has not had a major impact in reducing mastectomy rates or demand for immediate reconstruction. It has probably increased surgical workload of plastic surgeons as these cases are often performed as joint procedures. http://dx.doi.org/10.1016/j.ejso.2014.02.097
ABSTRACTS
(3.2%) had metastases on ANC. 41/72 patients had macrometastases micrometastases on OSNA, and 17/41 (41.4%) had metastases on ANC. On comparison with national data, we had a higher proportion of micrometastases. We also compared the result to a previous study carried out here prior to the introduction of OSNA, and SLNB positivity has increased from 21% to 46.4%. Conclusions: There has been a marked increase in SLNB positivity, and the rate is higher in Liverpool than in the UK overall. There is a high rate of ANC positivity if macrometastases are found on OSNA and a very low rate if only micrometastases are found. http://dx.doi.org/10.1016/j.ejso.2014.02.094
P095. Is sentinel node biopsy necessary in patients undergoing mastectomy for DCIS? Anna Conway, Christopher Rustom, Rosemary Wills, Adrian Ball, Adam Stacey-Clear, Shamaela Waheed Surrey and Sussex Healthcare NHS Trust, Redhill, UK Introduction: NICE guidance recommends patients have sentinel node biopsy (SNB) if they are having mastectomy for ductal carcinoma in situ (DCIS)1. DCIS requiring mastectomy undergo SNB as an invasive component may be identified on final histology and cannot be performed once the breast is removed. The aim of this study was to review the histology of mastectomy specimens and the number upstaged to invasive disease. The number of positive sentinel nodes following SNB was also recorded. Method: The Somerset cancer database was searched to identify these patients treated over a four year period. Data collected included core biopsy, final histology, size of DCIS and/or invasive component, SNB and subsequent axillary clearance results. Results: Thirty-two patients had a mastectomy for DCIS. Nine (28.1%) had an invasive component. 93.8% (30) had negative SNB, 7 of these patients had an invasive component (1 grade 1, 6 grade 2). Mean size of DCIS 42.8mm. Mean size of invasive component 29mm. Two patients had positive SNBs (2/8 and 1/16 after clearance). Both had grade 3 invasive disease. Conclusion: SNB for pure DCIS is controversial but cannot be performed after mastectomy. Other studies have identified 0%2 to 12%3 positive SLNs in patients with DCIS. Despite small sample size, this study supports the use of SNB in patients undergoing mastectomy due to the upstaging to invasive disease. References [1] NICE Guidelines. CG80 Early and locally advanced breast cancer: Diagnosis and treatment. September 2010. [2] Farkas E.A, Stolier A.J, Teng S.C, Bolton J.S, Fuhrman G.M. An argument against routine sentinel node mapping for DCIS. Am Surg. 2004, 70:13-18 [3] Klauber-De More N, et al. Sentinel lymph node biopsy: is it indicated in patients with high-risk ductal carcinoma-in-situ and ductal carcinoma in situ with microinvasion? Ann Surg Oncol 2000, 7:636-642. http://dx.doi.org/10.1016/j.ejso.2014.02.095
P096. A review of the assessment of male breast patients, with special reference to the use of imaging with digital breast tomosynthesis (DBT) and sonography Shazad Khaliq, Anita Maria Huws, T. Ifan Patchell, Kanwaljit Dhande, Saira Khawaja, Khaldoun Nadi, Yousef Sharaiha, Simon Holt Prince Philip Hospital, Llanelli, UK Background: With the increase trend in gym use and the widespread use of protein-shakes and muscle bulking enhancements, the number of referrals of men with ‘breast lumps’ has increased. In addition statins are now widely
prescribed and this also has resulted in a surge of referrals to the male breast clinic. A review of the benefit of imaging and intervention was undertaken to assess whether resources are being utilised effectively. Methods: A retrospective review identified 132 male patients seen within a 2 year period. The following data was collected; age, patient history, presenting symptom, drug history, investigations, imaging, biopsy results, follow-up and management plan. The data was analysed and recorded. Results: 132 consecutive patients identified with an age range of 16 to 84 years, with a small peak at 20-30 years of age and then the largest peak at 60-69 years (25% of the cohort fell within this group). The commonest presenting symptom was a lump (64%), while 22% presented with tender swelling. 77.27% (102/132) had DBT performed, of which 6.86% (7/102 were indeterminate or malignant). Of the 7 abnormal mammograms (age range 49-84), 4 were biopsied and confirmed gynaecomastia, 2 represented invasive ductal carcinoma and 1 intracystic papillary carcinoma. There were 4 cancers (3.03%) in the total cohort, a metastatic deposit in the breast from a renal cell carcinoma was mammographically occult. 100% of the cohort were imaged sonographically. 71.97% (95/132) were diagnosed with gynaecomastia. 58.33% were discharged. Blood tests were requested on the whole cohort and 16.67% (22/132) had abnormal results, 10 of which required further follow-up or tertiary referral to endocrinology. 3.8% (5/132) had surgical treatment for gynaecomastia. Conclusions: Sonography and clinical examination appeared to be more sensitive than mammography in this cohort of patients. This coupled with our findings that indeterminate imaging was more prevalent over 50 may indicate that mammography may be more sensitive in men over 50. http://dx.doi.org/10.1016/j.ejso.2014.02.096
P097. Does therapeutic mammoplasty reduce demand for mastectomy & immediate reconstruction? Jennifer Pollard1, Pang Wong1, James Mansell2, Juliette Murray1, Alison Lannigan1, Julie Doughty2, Laszlo Romics3, Sheila Stallard2, Christopher Wilson2 1 NHS Lanarkshire, Lanarkshire, UK 2 Western Infirmary, Glasgow, UK 3 Victoria Infirmary, Glasgow, UK Introduction: Therapeutic mammoplasty (TM) is increasing in popularity as a method for enhancing breast conserving surgery. Studies have shown it is oncologically safe, whilst improving cosmetic outcome. TM has been gaining popularity in West of Scotland over the past five years. Initially it was thought this may reduce requirement for mastectomy and immediate reconstruction. We have recorded type of surgery patients would have required had they not been suitable for TM, looking at changing demographic of surgical workload. Methods: Prospective data collected about patients undergoing TM in West of Scotland since 2011 in Victoria Infirmary, Western Infirmary and in Lanarkshire. We reviewed clinical indications for TM, surgical alternative, Body Mass Index (BMI) and smoker status. Results: 79 patients were identified. In 67 cases, alternative surgical option of mastectomy or standard conservation was recorded. Mean BMI was 29. 41% of patients had contralateral surgery for symmetry at the same time. In 28 cases (35%) TM avoided need for mastectomy. In 39 cases (49%) it was felt that cosmetic result would be improved by TM compared with standard conservation. During the study period, rates of mastectomy with immediate reconstruction as a proportion of total number of treated cancers have remained similar. Conclusions: Whilst introduction of TM in our region has improved options offered to patients and likely cosmetic outcomes, it has not had a major impact in reducing mastectomy rates or demand for immediate reconstruction. It has probably increased surgical workload of plastic surgeons as these cases are often performed as joint procedures. http://dx.doi.org/10.1016/j.ejso.2014.02.097