P64. Diagnosis of atypical ductal hyperplasia: A local audit

ABSTRACTS Introduction: The National Mastectomy and Breast Reconstruction Audit 2011 reviewed breast surgery outcomes across England. Particular attention was paid to patients’ experiences, and NICE Guidance: Improving Outcomes in Breast Cancer also recommends auditing patients’ reports of physical consequences of surgery, pain being a highly significant factor. Methods: An audit was undertaken to determine the incidence of pain and nausea after mastectomy and breast reconstruction surgery. Data were collected from consecutive mastectomies and breast reconstructions, including analgesia administered, pain scores, presence of nausea, and whether pain limited physiotherapy. Results: 15 mastectomies and 10 breast reconstructions (LD flaps) were undertaken during the audit. For mastectomies no patients reported a pain score of 3/3; 1 patient described pain slightly limiting physiotherapy. 1 patient required antiemetics after the day of surgery. For breast reconstructions 20% (2) of patients reported pain scores of 3/3 in the first 24 hours, 2 patients reporting limitation in physiotherapy. 3 patients required antiemetics after the day of surgery. Conclusions: Mastectomy patients had low pain scores and little nausea throughout. Breast reconstruction patients had higher pain scores at all stages, and some limitation of physiotherapy. These results correlate well with the National Audit, where 6.2% of mastectomy and 16.5-21.1% of breast reconstruction patients reported severe pain in the first 24 hours. We conclude that we provide analgesia to a standard similar to that reported in the National Audit, but improvements can be made, particularly in breast reconstructions. A rolling audit was established to monitor outcomes in mastectomies and breast reconstructions. P63. Standardizing the morbidity data for oncoplastic breast surgery using the Clavien-Dindo grading system, a single centre experience Sarah Tyler The Royal Cornwall Hospital, Truro, UK Introduction: In 2011 the Royal Cornwall NHS Trust diagnosed 418 primary breast cancers and 33 recurrences, treatment for which included 491 surgical patient episodes. The aim was to assess postoperative complication rate of an extensive oncoplastic practice and compare it with published rates, introducing a validated grading model to enable inter-centre comparison. The Clavien-Dindo classification system is based on the type of therapy required to correct the complication and has been shown to be reliable and reproducible (1). Methods: Complications were prospectively and accurately recorded by clinicians and nursing staff, in all patient contact locations. Case notes were reviewed retrospectively. Results: Fifty-four complications were identified. Haematoma rate was 3% (n¼15), infection rate 5% (n¼25) and wound necrosis rate 2.8% (n¼14). Using the Clavien-Dindo model, this translated to 26% grade 1, 35% grade 2, 31%grade 3 and 2% grade 4. Conclusions: These complication rates are comparable with those previously published which describe haematoma rates up to 11% (2) and infection rates of 2-3% (3). Whilst these figures are important for individual units, it is the use of a standardized grading system that will identify and standardize the impact that complications have to the patient and the financial burden of the unit, allowing inter-unit comparison and guide improvements to service provision. P64. Diagnosis of atypical ductal hyperplasia: A local audit Lily Li, Steven Goh Peterborough City Hospital, Peterborough, UK Introduction: Atypical ductal hyperplasia (ADH) is an uncommon breast lesion that confers an increased risk for invasive breast cancer. In 30% of cases ADH found on core biopsy is histologically ‘up-graded’ to cancer after surgical excision. Traditional teaching advises that all cases should undergo surgical excision to exclude malignancy. We assessed

1123 our practice in diagnosing and treating ADH at a busy district general hospital. Methods: A retrospective review of all cases of needle biopsy-proven ADH between 2006 and 2011 was conducted. Rates of re-biopsy of equivocal cases using large-gauge vacuum-assisted systems (10 & 14G VACORA), surgical excision, and histological upgrading after excision were analysed. Data were obtained from case notes, radiology and histopathology reports. Results: 41 patients were included (mean age 57 years). 12 patients underwent repeat biopsy using VACORA for equivocal histology. Repeat VACORA changed diagnosis in 5 (42%) cases. 3 patients were upgraded (2 to DCIS, 1 to invasive cancer); 2 patients were downgraded (benign pathology only) and these 2 patients were spared surgery. 38 (93%) went on to have surgical excision, and 13 out of 38 (34%) were histologically upgraded to DCIS or invasive carcinoma. 4 (11%) underwent further cancer surgery for incomplete margins. Conclusion: The high proportion of histological upgrading after surgical excision justifies our continued practice of excision in all cases of ADH. VACORA is a useful adjunct in cases of equivocal histology and may reduce the number of open excision biopsies. Our practice and results are in-line with published figures. P65. Patients with metastatic nodes diagnosed pre-operatively are a high risk cohort Cheryl Lobo, B. Ozdemir, Chris Honstvet, Tracey Irvine Royal Surrey County Hospital, Guildford, UK Introduction: All patients with breast cancer should have an axillary ultrasound +/- fine needle aspiration/core as part of their pre-operative work up. Node positive patients then proceed to have axillary clearance. We noticed that these patients seemed to have a high disease burden in the axilla and wished to review our cases as knowledge of this fact preoperatively may alter management. Method: This was a retrospective case note review of patients who had node positive disease diagnosed pre-operatively in our unit from January 2009 to December 2011. All patients had surgery which included axillary clearance with curative intent. Patients who had neoadjuvant chemotherapy were excluded. Results: There were 62 patients included in the study. 23 patients had neoadjuvant chemotherapy and were excluded. The patients were all female and ranged in age from 38 to 92. The median number of positive nodes in this group was 10.5 and the mean number of positive nodes was 12. Conclusions: In contrast to those patients who are node negative on preoperative work up, this cohort has a high level of axillary nodal disease. Patients who have 4 or more nodes positive will require post mastectomy radiotherapy and staging in many units. Knowledge of this pre-operatively may affect counselling regarding reconstructive options, decision making regarding timing of chemotherapy and may prevent extensive surgery in patients who have distal metastases. Further work is needed to see if a staging these patients routinely detects distal disease. P66. Sentinel lymph node biopsy: What’s the right answer, before or after NACT? Hiba Fatayer On behalf of Leeds Breast Group Leeds General Infirmary, Leeds, UK Introduction: The optimal timing for Sentinel lymph node biopsy (SLNB) in relation to neoadjuvant chemotherapy (NACT) remains controversial. In this study we report our experience of SLNB and lymph node (LN) status before and after NACT. Methods: Retrospective analysis of patients diagnosed with invasive breast cancer and treated with NACT between 2005 and 2009. Patients with confirmed axillary metastasis on initial cytology (FNAC) or SLNB pre-NACT (n¼70) and SLNB post-NACT (n¼20) were included in this