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Retrospective analysis of the use of isotope injection as single tracer in sentinel lymph node biopsy
ABSTRACTS Method: A retrospective data collection for all patients undergoing BCS +/ localisation from March eSept 2014 and March-Sept 2015. Results: In total 366 patients had surgery for breast cancer during the two time periods: 2014 cohort BCS n¼85/173 (49%), 2015 cohort BCS n¼122/ 193 (63%; p¼0.007). Of 189 patients undergoing BCS excluding therapeutic mammoplasty, 77 were from 2014, and 112 from 2015. There were higher numbers of impalpable disease in 2014 v 2015 (49% v 59%; p¼NS). The overall re-operation rate was 12%, with a trend to a reduction over time: 16% in 2014 vs 9% in 2015 (p¼0.12). Further cavity shavings were taken in 54% of patients with an increase from 2014 (43%) to 2015 (62%; p¼0.01). There were 131 cavity shavings submitted, of which 17 (13%) had further disease, with no significant difference between the two time cohorts. Three patients in 2014 required more than one additional procedure to achieve clear margins compared with one in 2015 (p¼NS). Conclusions: BCS rates have increased over the two time periods. There is a trend towards fewer re-operations for positive margins with the use of specimen XRay, despite more impalpable disease in the second cohort. There was an increase in the rate of cavity shavings, which may impact the pathology services and the cosmetic outcomes.
S31 Introduction: Use of both Technetium 99m isotope and patent blue dye is standard practice in localisation of the sentinel lymph node (SLN) in breast surgery. However the patent blue dye is associated with a significant risk of anaphylactic reaction and can detriment the physical view of the operative site during surgery. In our unit blue dye is used in selected patients. We aimed to review the long term effect of patients undergoing SLN biopsy without the use of blue dye compared to those undergoing dual tracer SLN biopsy. Method: Blue dye injection was omitted in those with a strong signal in the axilla after isotope injection or had a past history of allergic reaction to multiple medications. Notes of all patients undergoing SLNB from 1/1/ 2011 to 31/12/2011 were retrieved and analysed for patient demographics and whether blue dye was omitted or not. Follow up data of these patients were analysed. Results: 99 patients underwent SLNB during the study period. All cases were female. 34 patients had only isotope injected whilst 65 had both tracers injected. At 4 year follow up there were no regional or distant recurrence in the single tracer group (0%) compared to 2 patients developing distant recurrence in the dual tracer group (3%). Conclusions: Omitting blue dye in selected patients appears to be safe and reduces the significant side effects of using blue dye in this group of patients.
http://dx.doi.org/10.1016/j.ejso.2016.02.123 http://dx.doi.org/10.1016/j.ejso.2016.02.125
P071. Re-operation rates in therapeutic mammoplasty, can they be predicted? A large single-centre cohort Mary Venn, Ilyena Froud, Caroline Mortimer, Neeraj Garg Ipswich Hospital NHS Trust, Suffolk, UK
P073. Breast lesions of uncertain malignant potential (B3): Outcomes of a district general hospital Raj Badiani, Rachel Bryce, Diana Murariu, Habib Charfare Bedford Hospital, Bedford, UK
Introduction: Therapeutic mammoplasty is safe with high patient satisfaction. Re-excision rates are low compared to the national wide local excision rate of up to 25%. Patients are offered therapeutic mammoplasty after review of tumour size and position, breast volume and discussion with the multidisciplinary team. Here we present a review of patients who required re-operation after therapeutic mammoplasty to ascertain whether there are any predictive histopathological or radiological factors for margin involvement. Methods: All cases of therapeutic mammoplasty performed by a single surgeon over a three year period from 1st January 2013 were identified. Patient demographics, clinical details, pre-operative radiology, biopsies and final histopathology were recorded. Cases with margin involvement were assessed with both histological and radiological review and analysed for common factors. Results: 81 patients underwent therapeutic mammoplasty in the study period to date. They included patients with multifocal disease, large tumours and large breast volumes. 88% of cases had uninvolved resection margins following primary surgery. Nine cases required re-operation of which seven had margin re-excision and two underwent completion mastectomy. No radiological or histopathological factors including tumour size and total breast volume could be identified to predict which patients would require re-operation. Conclusion: The low rate of margin involvement in this series confirms that our current practice in patient selection for therapeutic mammoplasty is appropriate, can be determined by the multidisciplinary team and offers patients almost 90% chance of complete excision with a single operation. We have no evidence to suggest those cases requiring re-operation could have been predicted.
Introduction: B3 lesions are traditionally subject to open diagnostic excision biopsy due to uncertain malignant potential. Surgical excision carries operative and anaesthetic risks, with potential for excision of benign lesions that may otherwise be observed, and may cause no detriment to the patient Methods: A prospective study was performed of all patients presenting with B3 breast lesions on core biopsy via the Bedford Hospital Breast MDT database between November 2008 and July 2015. Data was collected using clinical notes and electronic patient records, with analysis of histological outcomes at surgical excision in comparison to core biopsy. Results: 136 patients with B3 lesions on core biopsy were identified with a mean age of 55.8 years. Histological subclassification of these demonstrated common subtypes of B3 lesions including atypical ductal hyperplasia (ADH, 21%), radial scar or complex sclerosing lesions (RS/CSL, 18%), papillary lesions (PL, 18%), and cellular fibroepithelial lesions (CFL, 12%). 114 patients underwent subsequent surgical excision. Presence of ADH on core biopsy predicted malignancy at a rate of 50%. 94% of cases with CFL were benign at final histology. Overall, 11% of B3 lesions demonstrated invasive cancer on final histology, and 18% demonstrated ductal carcinoma in situ (DCIS). Conclusion: Among B3 lesions, the presence of ADH was the strongest predictive factor for underlying malignancy, with cellular fibroepithelial lesions demonstrating the least malignant potential. All patients that underwent surgical excision of lesions that went on to demonstrate malignancy had breast cancer follow up. The vast majority of non-surgically managed lesions underwent radiographic surveillance. http://dx.doi.org/10.1016/j.ejso.2016.02.126
http://dx.doi.org/10.1016/j.ejso.2016.02.124
P072. Retrospective analysis of the use of isotope injection as single tracer in sentinel lymph node biopsy Chloe Merrion, Rachel Gravell, Hamed Khan University Hospitals Coventry and Warwickshire, Coventry, UK
P074. Rapid Access Breast Clinic: Improving compliance with best practice Chiara Sirianni, Katie Mellor, Andy Gash Betsi Cadwaladr University Health Board, Bangor, UK Introduction: A previous audit on the accuracy of assessments in our Rapid Access Breast Clinic (RABC) identified several areas for
S31 Introduction: Use of both Technetium 99m isotope and patent blue dye is standard practice in localisation of the sentinel lymph node (SLN) in breast surgery. However the patent blue dye is associated with a significant risk of anaphylactic reaction and can detriment the physical view of the operative site during surgery. In our unit blue dye is used in selected patients. We aimed to review the long term effect of patients undergoing SLN biopsy without the use of blue dye compared to those undergoing dual tracer SLN biopsy. Method: Blue dye injection was omitted in those with a strong signal in the axilla after isotope injection or had a past history of allergic reaction to multiple medications. Notes of all patients undergoing SLNB from 1/1/ 2011 to 31/12/2011 were retrieved and analysed for patient demographics and whether blue dye was omitted or not. Follow up data of these patients were analysed. Results: 99 patients underwent SLNB during the study period. All cases were female. 34 patients had only isotope injected whilst 65 had both tracers injected. At 4 year follow up there were no regional or distant recurrence in the single tracer group (0%) compared to 2 patients developing distant recurrence in the dual tracer group (3%). Conclusions: Omitting blue dye in selected patients appears to be safe and reduces the significant side effects of using blue dye in this group of patients.
http://dx.doi.org/10.1016/j.ejso.2016.02.123 http://dx.doi.org/10.1016/j.ejso.2016.02.125
P071. Re-operation rates in therapeutic mammoplasty, can they be predicted? A large single-centre cohort Mary Venn, Ilyena Froud, Caroline Mortimer, Neeraj Garg Ipswich Hospital NHS Trust, Suffolk, UK
P073. Breast lesions of uncertain malignant potential (B3): Outcomes of a district general hospital Raj Badiani, Rachel Bryce, Diana Murariu, Habib Charfare Bedford Hospital, Bedford, UK
Introduction: Therapeutic mammoplasty is safe with high patient satisfaction. Re-excision rates are low compared to the national wide local excision rate of up to 25%. Patients are offered therapeutic mammoplasty after review of tumour size and position, breast volume and discussion with the multidisciplinary team. Here we present a review of patients who required re-operation after therapeutic mammoplasty to ascertain whether there are any predictive histopathological or radiological factors for margin involvement. Methods: All cases of therapeutic mammoplasty performed by a single surgeon over a three year period from 1st January 2013 were identified. Patient demographics, clinical details, pre-operative radiology, biopsies and final histopathology were recorded. Cases with margin involvement were assessed with both histological and radiological review and analysed for common factors. Results: 81 patients underwent therapeutic mammoplasty in the study period to date. They included patients with multifocal disease, large tumours and large breast volumes. 88% of cases had uninvolved resection margins following primary surgery. Nine cases required re-operation of which seven had margin re-excision and two underwent completion mastectomy. No radiological or histopathological factors including tumour size and total breast volume could be identified to predict which patients would require re-operation. Conclusion: The low rate of margin involvement in this series confirms that our current practice in patient selection for therapeutic mammoplasty is appropriate, can be determined by the multidisciplinary team and offers patients almost 90% chance of complete excision with a single operation. We have no evidence to suggest those cases requiring re-operation could have been predicted.
Introduction: B3 lesions are traditionally subject to open diagnostic excision biopsy due to uncertain malignant potential. Surgical excision carries operative and anaesthetic risks, with potential for excision of benign lesions that may otherwise be observed, and may cause no detriment to the patient Methods: A prospective study was performed of all patients presenting with B3 breast lesions on core biopsy via the Bedford Hospital Breast MDT database between November 2008 and July 2015. Data was collected using clinical notes and electronic patient records, with analysis of histological outcomes at surgical excision in comparison to core biopsy. Results: 136 patients with B3 lesions on core biopsy were identified with a mean age of 55.8 years. Histological subclassification of these demonstrated common subtypes of B3 lesions including atypical ductal hyperplasia (ADH, 21%), radial scar or complex sclerosing lesions (RS/CSL, 18%), papillary lesions (PL, 18%), and cellular fibroepithelial lesions (CFL, 12%). 114 patients underwent subsequent surgical excision. Presence of ADH on core biopsy predicted malignancy at a rate of 50%. 94% of cases with CFL were benign at final histology. Overall, 11% of B3 lesions demonstrated invasive cancer on final histology, and 18% demonstrated ductal carcinoma in situ (DCIS). Conclusion: Among B3 lesions, the presence of ADH was the strongest predictive factor for underlying malignancy, with cellular fibroepithelial lesions demonstrating the least malignant potential. All patients that underwent surgical excision of lesions that went on to demonstrate malignancy had breast cancer follow up. The vast majority of non-surgically managed lesions underwent radiographic surveillance. http://dx.doi.org/10.1016/j.ejso.2016.02.126
http://dx.doi.org/10.1016/j.ejso.2016.02.124
P072. Retrospective analysis of the use of isotope injection as single tracer in sentinel lymph node biopsy Chloe Merrion, Rachel Gravell, Hamed Khan University Hospitals Coventry and Warwickshire, Coventry, UK
P074. Rapid Access Breast Clinic: Improving compliance with best practice Chiara Sirianni, Katie Mellor, Andy Gash Betsi Cadwaladr University Health Board, Bangor, UK Introduction: A previous audit on the accuracy of assessments in our Rapid Access Breast Clinic (RABC) identified several areas for