- Email: [email protected]
P311 How to avoid unnecessary sentinel node biopsy in patients with ductal cancer in situ
14th St.Gallen International Breast Cancer Conference / The Breast 24S1 (2015) S87–S150
P309 The use of Tisseel fibrin sealant in seroma reduction after mastectomy – a pilot study Q.T. Tan1 *, C.M. Lee1 , V.K.M. Tan2 , K.W. Ong2 . 1 Singhealth-duke Breast, Singapore General Hospital, Singapore, Singapore, 2 Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore Goals: Postmastectomy seroma formation is very common. In some cases, it is associated with increased morbidity, hospital stay and risk of wound infection and breakdown Placement of a surgical drain is also associated with longer hospital stay, drain dislodgement, drain blockage, leaking around drain exit site and wound site infection. Various methods have been described to decrease postoperative seroma formation, including use of pressure garments, immobilization of the ipsilateral upper limb, quilting and use of sclerosing agents. Thus far, no method has been shown to be effective. We explore the use of fibrin sealant to the postmastectomy wound to reduce seroma formation through improved tissue adherence and hemostasis. Methods: In this pilot study, we compared the degree of seroma formation patients with 2 ml of Tisseel fibrin sealant applied to the post mastectomy wound cavity before closure with patients who undergo wound closure in the usual fashion (i.e. without the use of Tisseel). 10 patients were grouped into each arm and the amount of seroma formation (assessed by drain volume and volume of seroma fluid aspirated after drain removal) compared between patients with similar bra cup size and mastectomy specimen weight. Results: The volume of seroma fluid and time to drain removal is significantly reduced in patients who had application of fibrin sealant. Most patients recruited were of similar bra cup size (B) with median breast weight of 462.5 g for the Tisseel group and 600 g for the control group (p = 0.44). Median time to drain removal for the Tisseel group is 6.5 days compared to 10.5 days for the control group (p = 0.06). Median drain volume for the Tisseel group is 335 ml and 530 ml for the control group (p = 0.12). Median aspiration volume after drain removal for the Tisseel group is 52.5 ml and 89.5 ml for the control group (p = 0.12). Median total seroma volume for the Tisseel group is 507.5 ml compared to 770 ml for the control group (p = 0.05). Conclusion: The use of fibrin sealants like Tisseel effectively reduces seroma formation. Fibrin sealants have a good safety profile, are easy to use and do not significantly increase operative time. However increased cost may pose to be a problem. A follow-up prospective study of a larger scale is underway to analyze the cost and benefits of this technique. Disclosure of Interest: No significant relationships. P310 Local recurrence rates are low in Japanese breast cancer patients after neoadjuvant chemotherapy T. Shigekawa *, A. Osaki, S. Ueda, H. Takeuchi, E. Hirokawa, I. Sugitani, M. Sugiyama, H. Shimada, T. Takahashi, T. Saeki. Breast Oncology, Saitama Medical University International Medical Center, Hidaka, Japan Goals: In a meta-analysis, it was shown that neoadjuvant chemotherapy (NAC) improved the rates of breast conservative treatment (BCT), and the patients ineligible for BCT have increasingly converted to be candidates for it after NAC, although questions whether BCT provides adequate local control often arise. There is few long-term treatment results about local recurrence (LR) after surgery in the patients treated with NAC in Japan. The goals of this study are to evaluate the rate and clinical characteristics of LR in these patients. Methods: This study included 101 patients whose symptoms corresponded to the American Joint Committee on Cancer Stage II
S133
or III breast cancer and who were treated between April 2007 and March 2010 with NAC that included anthracycline and/or taxane-based regimens and who had undergone definitive surgical therapy. All patients treated with BCT received radiation therapy postoperatively. Results: 46 patients (45.5%) received BCT and 55 patients (54.5%) received mastectomy. In both of these groups, median tumor size was 36 mm, and in BCT group, 6 patients (13.0%) had positive margins (defined as positive in case of ≤5 mm from the tumor). At a median follow-up of 59 months, 8 patients (7.9%) had LR and 19 (18.8%) had distant recurrence (DR). Of the 8 patients with LR, 7 patients had DR and only one patient had LR alone in the follow-up period. The median periods from surgery to LR were 20 months. In the 8 patients with LR, 6 patients had chest wall skin recurrence after mastectomy, and only 2 patients (4.3%; 2/46) had the ipsilateral breast recurrence after BCT. Conclusion: The rate of LR after surgery was low in Japanese highrisk breast cancer patients treated with neoadjuvant chemotherapy, and especially the ipsilateral breast recurrence after BCT was rare. LR occurred most frequently in the setting of DR. Disclosure of Interest: No significant relationships. P311 How to avoid unnecessary sentinel node biopsy in patients with ductal cancer in situ ˚ Bergkvist3 , S. Abdsaleh4 , A. Karakatsanis1 *, H. Oloffson2 , L.A. 5 1 1 M. Sund , F. Warnberg ¨ . Department for Surgical Sciences, Uppsala University, Uppsala, Sweden, 2 Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden, 3 Department of Surgical Sciences, Uppsala University, Department of Surgery, Central Hospital, V¨ aster˚ as, Uppsala University, Department of Surgery, Central Hospital, V¨ aster˚ as, V¨ aster˚ as, Sweden, 4 Department of Radiology, Oncology and Radiation Science, Uppsala University, Uppsala, Sweden, 5 Department of Surgical and Perioperative Sciences, Ume˚ a University, Ume˚ a, Sweden Goals: To assess preoperative Sienna+ injection (SPIO) for the detection of sentinel lymph node (SN) in patients with ductal cancer in situ (DCIS), and to perform SN biopsy only after a postoperative diagnosis of invasive cancer. Methods: In a pilot study, SPIO was injected 3 to 15 days before surgery in 12 patients that would undergo SN biopsy. Technetium and blue dye were used routinely at the time of surgery as usual. Pregnant or lactating women, as well as patients with known allergy to iron or dextran compounds, such as hemochromatosis or other iron overload were excluded. Additionally, a healthy volunteer was injected with SPIO in order to follow the decline of the magnetic signal in the SN over time. Results: In all patients, there was a good signal detected by the magnetometer (SentiMag® ) at surgery, and the SNs were detected in all patients. The relation of a good preoperative and intraoperative signal was a constant finding, regardless of the time elapsed between the preoperative injection and the date of surgery. In nine patients, the SNs were identified with all three methods. In two patients, the SNs were detected with the magnetometer only and, in one, with the magnetometer and Technetium, but not with the blue dye. No adverse effects were noted from SPIO injection. The specimens sent for pre- or post-operative mammographic localization were free from any disturbance of the visualization of the lesions. The histopathological examination was not disturbed, neither in the tumour nor in the SN. On the contrary, it seemed like the examination of frozen sections of SNs was easier as the SPIO was not accumulated in metastatic cells. In the volunteer, the counts in the axilla stayed persistently high for more than four weeks. Conclusion: The use of preoperative SPIO injection is a promising technique in order to avoid unnecessary preoperative SN biopsy in
S134
Poster Abstracts II / The Breast 24S1 (2015) S87–S150
patients with a preoperative diagnosis of DCIS. Morbidity related to SN biopsy will be reduced and potentially limit the cost of the procedure. A larger study will be consequently performed to evaluate the number of SN biopsies avoided in relation to the number of SN biopsies that have to be performed in a second operation. Disclosure of Interest: No significant relationships. P312 Influence of immediate breast reconstruction (IBR) on adjuvant therapy for breast cancer patients T. Nogami1 *, N. Taira1 , S. Watanabe2 , Y. Abe1 , T. Mizoo1 , T. Iwamoto1 , T. Motoki1 , T. Shien1 , Y. Kimata2 , H. Doihara1 . 1 Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan, 2 Plastic and Reconstructive Surgery, Okayama University Hospital, Okayama, Japan Goals: Although breast reconstruction has become a standard option for breast cancer patients because of cosmetic reasons, breast reconstruction has specific complications. These complications may obstruct adjuvant therapies to breast cancer, such as a delay of appropriate introduction of adjuvant chemotherapy. We investigated whether particularly immediate breast reconstruction (IBR) for breast cancer patients did harm. Methods: From 2004 to 2013, 494 breast cancer patients who had operative treatment for breast cancer at Okayama University Hospital (exclude the patients who received preoperative chemotherapy or had Stage IV breast cancer). First, we chose the patients treated with mastectomy who had adaptation of postmastectomy radiotherapy (PMRT), and divided into two groups; IRB and non-IRB. We investigate whether appropriate adaptation of Radiotherapy was done in the groups. Second, we chose the patients who treated with adjuvant chemotherapy, and divided into also two groups. We investigated the period between surgery and introduction of adjuvant chemotherapy, and compared the two groups. Results: First, 31 patients had adaptation of PMRT. 11 (33%) patients were IBR group, and 20 (67%) patients were non-IRB group. In IBR group, 8 (73%) patients received PMRT. In non-IRB group, 15 (75%) patients received PMRT. There is no significant difference between IBR group and non-IBR groups (p = 0.89). Second, 121 patients received adjuvant chemotherapy. 29 (24%) patients were treated with IBR. The average period between surgery and adjuvant chemotherapy was 35 days in IBR groups, and 36 days in non-IBR groups, respectively. There is no significant difference between IBR group and non-IBR groups (p = 0.5). Completion rate of adjuvant chemotherapy was 97% in IBR group and 96% in non-IBR group, respectively. There is also no significant difference between IBR group and non-IBR groups (p = 0.91). Conclusion: In this study, IBR for breast cancer patients did not harm. We must do best for the patients continuously. Disclosure of Interest: The authors have no conflict of interest to declare. P313 A new predictive score for axillary lymph node metastases in breast cancer patients T. Ogura *, T. Kinoshita, K. Jimbo, S. Asaga, T. Hojo. Breast Surgery Division, National Cancer Center Hospital, Tokyo, Japan Goals: The American College of Surgeons Oncology Group (ACOSOG) Z0011 trial demonstrated no difference in overall survival or localregional recurrence rates between patients planned for breast conservation therapy including whole breast irradiation with one or two positive sentinel lymph nodes (SLNs) randomly selected to undergo axillary lymph node dissection (ALND) versus no further surgery. But, non-SLN status is important for the omitting ALND
and the decision of the intensity of adjuvant therapy. Detection of SLN metastases in breast cancer patients has been determined by conventional histological examination or by molecular biological examination such as one step nucleic acid amplification (OSNA). We examine the assessment using a combination of histological examination and OSNA and the possibility of omitting ALND. Methods: We included 1158 consecutive patients with clinical node-negative cTis-cT3 primary breast cancer who underwent SLN biopsy with intraoperative multi-section histological examination and OSNA between February 2010 and June 2013 at our institution. 311 patients (27%) with positive SLN metastases by either histology or OSNA underwent further ALND. We allotted 3 points to macro metastasis by histology, 2 to micro metastasis, and 1 to isolated tumor cells (ITC). We allotted 3 points to 2+ by OSNA, 2 to 1+, 1 to +I. We defined “NCC-SLN metastatic score (NCS score)” as the sum total points and predicted the existence of non-SLN metastases. Results: There was a strong correlation between NCS score and nonSLN metastases detection rate, and the correlation coefficient was 0.72. In the invasive lobular carcinoma the correlation coefficient was low (0.45), whereas in the invasive ductal carcinoma the correlation coefficient was high (0.72). The non-SLN metastases detection rate was low (12%) in patients whose NCS score is 3 and below. In patients whose NCS score is from 4 to 12 and 13 and above, the non-SLN metastases detection rate was 37% and 75%. Average number of metastatic non-SLNs is 0.4 and 3.4 in patients whose score is 9 and below and 10 and above respectively. Conclusion: NCS score had a strong correlation with the non-SLN metastases detection rate in the invasive ductal carcinoma. By using this score we could decide the cases that we omit the further ALND. Disclosure of Interest: No significant relationships. P314 Preoperative identification of early breast cancer patients for safely avoiding axillary surgery C. Listorti1 *, A. Rulli1 , E. Prosperi2 , P. Covarelli3 , F. Barberini1 . 1 Breast Unit, General and Oncological Surgical Unit, Department of Surgery, University of Perugia, Perugia, Italy, 2 Institute of Pathological Anatomy and Histology, University of Perugia, Perugia, Italy, 3 General and Oncological Surgical Unit, Department of Surgery, University of Perugia, Perugia, Italy Goals: Almost 30% of patients with breast cancer die despite earlier diagnosis with screening programs and therapeutical improvements. Locoregional metastases occur even in less indolent types of early stage breast cancer, impacting disease free, overall survival and quality of life. For this reason, even if a more conservative surgical approach has been indicated, axillary lymph nodes clearance is still performed in case of sentinel lymph node micrometastasis and Luminal tumor. We conducted a retrospective study in order to find objective parameters to preoperatively identify low risk early breast cancer patients with sentinel node micrometastasis for which is safe to avoid axillary clearance. Methods: We analyzed data collected between December 2012 and December 2014. Early stage breast cancer patients with clinically negative axilla underwent breast surgery and sentinel node biopsy. Metastases at sentinel lymph node were intraoperatively detected with one-step nucleic acid amplification (OSNA) assay, which analyzes cytokeratin 19 mRNA copy number in the whole lymph node. Results: A total of 392 patients underwent breast surgery and sentinel node biopsy. Analysis was conducted on 348 patients, among which 99 had sentinel node metastasis. Forty-seven patients had macrometastasis while 52 patients had sentinel node micrometastasis. Among these cases, 40 patients underwent axillary clearance. We found 8 patients (20%) with non-sentinel axillary lymph nodes metastases. We then selected patients with
P309 The use of Tisseel fibrin sealant in seroma reduction after mastectomy – a pilot study Q.T. Tan1 *, C.M. Lee1 , V.K.M. Tan2 , K.W. Ong2 . 1 Singhealth-duke Breast, Singapore General Hospital, Singapore, Singapore, 2 Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore Goals: Postmastectomy seroma formation is very common. In some cases, it is associated with increased morbidity, hospital stay and risk of wound infection and breakdown Placement of a surgical drain is also associated with longer hospital stay, drain dislodgement, drain blockage, leaking around drain exit site and wound site infection. Various methods have been described to decrease postoperative seroma formation, including use of pressure garments, immobilization of the ipsilateral upper limb, quilting and use of sclerosing agents. Thus far, no method has been shown to be effective. We explore the use of fibrin sealant to the postmastectomy wound to reduce seroma formation through improved tissue adherence and hemostasis. Methods: In this pilot study, we compared the degree of seroma formation patients with 2 ml of Tisseel fibrin sealant applied to the post mastectomy wound cavity before closure with patients who undergo wound closure in the usual fashion (i.e. without the use of Tisseel). 10 patients were grouped into each arm and the amount of seroma formation (assessed by drain volume and volume of seroma fluid aspirated after drain removal) compared between patients with similar bra cup size and mastectomy specimen weight. Results: The volume of seroma fluid and time to drain removal is significantly reduced in patients who had application of fibrin sealant. Most patients recruited were of similar bra cup size (B) with median breast weight of 462.5 g for the Tisseel group and 600 g for the control group (p = 0.44). Median time to drain removal for the Tisseel group is 6.5 days compared to 10.5 days for the control group (p = 0.06). Median drain volume for the Tisseel group is 335 ml and 530 ml for the control group (p = 0.12). Median aspiration volume after drain removal for the Tisseel group is 52.5 ml and 89.5 ml for the control group (p = 0.12). Median total seroma volume for the Tisseel group is 507.5 ml compared to 770 ml for the control group (p = 0.05). Conclusion: The use of fibrin sealants like Tisseel effectively reduces seroma formation. Fibrin sealants have a good safety profile, are easy to use and do not significantly increase operative time. However increased cost may pose to be a problem. A follow-up prospective study of a larger scale is underway to analyze the cost and benefits of this technique. Disclosure of Interest: No significant relationships. P310 Local recurrence rates are low in Japanese breast cancer patients after neoadjuvant chemotherapy T. Shigekawa *, A. Osaki, S. Ueda, H. Takeuchi, E. Hirokawa, I. Sugitani, M. Sugiyama, H. Shimada, T. Takahashi, T. Saeki. Breast Oncology, Saitama Medical University International Medical Center, Hidaka, Japan Goals: In a meta-analysis, it was shown that neoadjuvant chemotherapy (NAC) improved the rates of breast conservative treatment (BCT), and the patients ineligible for BCT have increasingly converted to be candidates for it after NAC, although questions whether BCT provides adequate local control often arise. There is few long-term treatment results about local recurrence (LR) after surgery in the patients treated with NAC in Japan. The goals of this study are to evaluate the rate and clinical characteristics of LR in these patients. Methods: This study included 101 patients whose symptoms corresponded to the American Joint Committee on Cancer Stage II
S133
or III breast cancer and who were treated between April 2007 and March 2010 with NAC that included anthracycline and/or taxane-based regimens and who had undergone definitive surgical therapy. All patients treated with BCT received radiation therapy postoperatively. Results: 46 patients (45.5%) received BCT and 55 patients (54.5%) received mastectomy. In both of these groups, median tumor size was 36 mm, and in BCT group, 6 patients (13.0%) had positive margins (defined as positive in case of ≤5 mm from the tumor). At a median follow-up of 59 months, 8 patients (7.9%) had LR and 19 (18.8%) had distant recurrence (DR). Of the 8 patients with LR, 7 patients had DR and only one patient had LR alone in the follow-up period. The median periods from surgery to LR were 20 months. In the 8 patients with LR, 6 patients had chest wall skin recurrence after mastectomy, and only 2 patients (4.3%; 2/46) had the ipsilateral breast recurrence after BCT. Conclusion: The rate of LR after surgery was low in Japanese highrisk breast cancer patients treated with neoadjuvant chemotherapy, and especially the ipsilateral breast recurrence after BCT was rare. LR occurred most frequently in the setting of DR. Disclosure of Interest: No significant relationships. P311 How to avoid unnecessary sentinel node biopsy in patients with ductal cancer in situ ˚ Bergkvist3 , S. Abdsaleh4 , A. Karakatsanis1 *, H. Oloffson2 , L.A. 5 1 1 M. Sund , F. Warnberg ¨ . Department for Surgical Sciences, Uppsala University, Uppsala, Sweden, 2 Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden, 3 Department of Surgical Sciences, Uppsala University, Department of Surgery, Central Hospital, V¨ aster˚ as, Uppsala University, Department of Surgery, Central Hospital, V¨ aster˚ as, V¨ aster˚ as, Sweden, 4 Department of Radiology, Oncology and Radiation Science, Uppsala University, Uppsala, Sweden, 5 Department of Surgical and Perioperative Sciences, Ume˚ a University, Ume˚ a, Sweden Goals: To assess preoperative Sienna+ injection (SPIO) for the detection of sentinel lymph node (SN) in patients with ductal cancer in situ (DCIS), and to perform SN biopsy only after a postoperative diagnosis of invasive cancer. Methods: In a pilot study, SPIO was injected 3 to 15 days before surgery in 12 patients that would undergo SN biopsy. Technetium and blue dye were used routinely at the time of surgery as usual. Pregnant or lactating women, as well as patients with known allergy to iron or dextran compounds, such as hemochromatosis or other iron overload were excluded. Additionally, a healthy volunteer was injected with SPIO in order to follow the decline of the magnetic signal in the SN over time. Results: In all patients, there was a good signal detected by the magnetometer (SentiMag® ) at surgery, and the SNs were detected in all patients. The relation of a good preoperative and intraoperative signal was a constant finding, regardless of the time elapsed between the preoperative injection and the date of surgery. In nine patients, the SNs were identified with all three methods. In two patients, the SNs were detected with the magnetometer only and, in one, with the magnetometer and Technetium, but not with the blue dye. No adverse effects were noted from SPIO injection. The specimens sent for pre- or post-operative mammographic localization were free from any disturbance of the visualization of the lesions. The histopathological examination was not disturbed, neither in the tumour nor in the SN. On the contrary, it seemed like the examination of frozen sections of SNs was easier as the SPIO was not accumulated in metastatic cells. In the volunteer, the counts in the axilla stayed persistently high for more than four weeks. Conclusion: The use of preoperative SPIO injection is a promising technique in order to avoid unnecessary preoperative SN biopsy in
S134
Poster Abstracts II / The Breast 24S1 (2015) S87–S150
patients with a preoperative diagnosis of DCIS. Morbidity related to SN biopsy will be reduced and potentially limit the cost of the procedure. A larger study will be consequently performed to evaluate the number of SN biopsies avoided in relation to the number of SN biopsies that have to be performed in a second operation. Disclosure of Interest: No significant relationships. P312 Influence of immediate breast reconstruction (IBR) on adjuvant therapy for breast cancer patients T. Nogami1 *, N. Taira1 , S. Watanabe2 , Y. Abe1 , T. Mizoo1 , T. Iwamoto1 , T. Motoki1 , T. Shien1 , Y. Kimata2 , H. Doihara1 . 1 Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan, 2 Plastic and Reconstructive Surgery, Okayama University Hospital, Okayama, Japan Goals: Although breast reconstruction has become a standard option for breast cancer patients because of cosmetic reasons, breast reconstruction has specific complications. These complications may obstruct adjuvant therapies to breast cancer, such as a delay of appropriate introduction of adjuvant chemotherapy. We investigated whether particularly immediate breast reconstruction (IBR) for breast cancer patients did harm. Methods: From 2004 to 2013, 494 breast cancer patients who had operative treatment for breast cancer at Okayama University Hospital (exclude the patients who received preoperative chemotherapy or had Stage IV breast cancer). First, we chose the patients treated with mastectomy who had adaptation of postmastectomy radiotherapy (PMRT), and divided into two groups; IRB and non-IRB. We investigate whether appropriate adaptation of Radiotherapy was done in the groups. Second, we chose the patients who treated with adjuvant chemotherapy, and divided into also two groups. We investigated the period between surgery and introduction of adjuvant chemotherapy, and compared the two groups. Results: First, 31 patients had adaptation of PMRT. 11 (33%) patients were IBR group, and 20 (67%) patients were non-IRB group. In IBR group, 8 (73%) patients received PMRT. In non-IRB group, 15 (75%) patients received PMRT. There is no significant difference between IBR group and non-IBR groups (p = 0.89). Second, 121 patients received adjuvant chemotherapy. 29 (24%) patients were treated with IBR. The average period between surgery and adjuvant chemotherapy was 35 days in IBR groups, and 36 days in non-IBR groups, respectively. There is no significant difference between IBR group and non-IBR groups (p = 0.5). Completion rate of adjuvant chemotherapy was 97% in IBR group and 96% in non-IBR group, respectively. There is also no significant difference between IBR group and non-IBR groups (p = 0.91). Conclusion: In this study, IBR for breast cancer patients did not harm. We must do best for the patients continuously. Disclosure of Interest: The authors have no conflict of interest to declare. P313 A new predictive score for axillary lymph node metastases in breast cancer patients T. Ogura *, T. Kinoshita, K. Jimbo, S. Asaga, T. Hojo. Breast Surgery Division, National Cancer Center Hospital, Tokyo, Japan Goals: The American College of Surgeons Oncology Group (ACOSOG) Z0011 trial demonstrated no difference in overall survival or localregional recurrence rates between patients planned for breast conservation therapy including whole breast irradiation with one or two positive sentinel lymph nodes (SLNs) randomly selected to undergo axillary lymph node dissection (ALND) versus no further surgery. But, non-SLN status is important for the omitting ALND
and the decision of the intensity of adjuvant therapy. Detection of SLN metastases in breast cancer patients has been determined by conventional histological examination or by molecular biological examination such as one step nucleic acid amplification (OSNA). We examine the assessment using a combination of histological examination and OSNA and the possibility of omitting ALND. Methods: We included 1158 consecutive patients with clinical node-negative cTis-cT3 primary breast cancer who underwent SLN biopsy with intraoperative multi-section histological examination and OSNA between February 2010 and June 2013 at our institution. 311 patients (27%) with positive SLN metastases by either histology or OSNA underwent further ALND. We allotted 3 points to macro metastasis by histology, 2 to micro metastasis, and 1 to isolated tumor cells (ITC). We allotted 3 points to 2+ by OSNA, 2 to 1+, 1 to +I. We defined “NCC-SLN metastatic score (NCS score)” as the sum total points and predicted the existence of non-SLN metastases. Results: There was a strong correlation between NCS score and nonSLN metastases detection rate, and the correlation coefficient was 0.72. In the invasive lobular carcinoma the correlation coefficient was low (0.45), whereas in the invasive ductal carcinoma the correlation coefficient was high (0.72). The non-SLN metastases detection rate was low (12%) in patients whose NCS score is 3 and below. In patients whose NCS score is from 4 to 12 and 13 and above, the non-SLN metastases detection rate was 37% and 75%. Average number of metastatic non-SLNs is 0.4 and 3.4 in patients whose score is 9 and below and 10 and above respectively. Conclusion: NCS score had a strong correlation with the non-SLN metastases detection rate in the invasive ductal carcinoma. By using this score we could decide the cases that we omit the further ALND. Disclosure of Interest: No significant relationships. P314 Preoperative identification of early breast cancer patients for safely avoiding axillary surgery C. Listorti1 *, A. Rulli1 , E. Prosperi2 , P. Covarelli3 , F. Barberini1 . 1 Breast Unit, General and Oncological Surgical Unit, Department of Surgery, University of Perugia, Perugia, Italy, 2 Institute of Pathological Anatomy and Histology, University of Perugia, Perugia, Italy, 3 General and Oncological Surgical Unit, Department of Surgery, University of Perugia, Perugia, Italy Goals: Almost 30% of patients with breast cancer die despite earlier diagnosis with screening programs and therapeutical improvements. Locoregional metastases occur even in less indolent types of early stage breast cancer, impacting disease free, overall survival and quality of life. For this reason, even if a more conservative surgical approach has been indicated, axillary lymph nodes clearance is still performed in case of sentinel lymph node micrometastasis and Luminal tumor. We conducted a retrospective study in order to find objective parameters to preoperatively identify low risk early breast cancer patients with sentinel node micrometastasis for which is safe to avoid axillary clearance. Methods: We analyzed data collected between December 2012 and December 2014. Early stage breast cancer patients with clinically negative axilla underwent breast surgery and sentinel node biopsy. Metastases at sentinel lymph node were intraoperatively detected with one-step nucleic acid amplification (OSNA) assay, which analyzes cytokeratin 19 mRNA copy number in the whole lymph node. Results: A total of 392 patients underwent breast surgery and sentinel node biopsy. Analysis was conducted on 348 patients, among which 99 had sentinel node metastasis. Forty-seven patients had macrometastasis while 52 patients had sentinel node micrometastasis. Among these cases, 40 patients underwent axillary clearance. We found 8 patients (20%) with non-sentinel axillary lymph nodes metastases. We then selected patients with