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0-1. Lymphoscintigraphy for locating the sentinel lymph node in patients with breast cancer
The Brrar (1997) 6, 225-255 0 1997 Pearwn Profewonal Ltd
ABSTRACTS
5th Nottingham International Breast Cancer Conference 17-19 September 1997
O-l. Lymphoscintigraphy for locating the sentinel lymph node in patients with breast cancer Gill PG, Hall VE, Kirkwood I, Chatterton BE, Coventry B, Vernon-Roberts E Breast Unit, Royal Adelaide Hospital, South Australia A prospective study was undertaken to locate sentinel nodes (SN) (first draining LN) using lymphoscintigraphy (LS) and peritumoural blue dye (BD) injection at surgery in patients with breast carcinoma, and determine the accuracy of SN status in staging the axilla. 36 female patients with breast carcinoma underwent LS using yymTc labelled antimony sulphide colloid (99mTc-Sb2S3)prior to surgery. The radionuclide was injected at the tumour margin. A skin marking overlying the SN was made. The BD technique was replaced by intraoperative gamma probe for intraoperative SN localisation. The SN was resected and pathological assessment of the SN obtained. Axillary SN were identified in 30/36 (83%) of patients. The SN status predicted the axillary LN status in 28/30 (93%). There were 2 false negative cases (false negative - 8.3%). Our results suggest that LS, BD and intraoperative gamma probe allow localisation of SN. The SN status is a good predictor of the axillary LN status.
O-2. New approach to therapeutic and diagnostic management of screen detected mammographic abnormalities: the ABBI system Menon M, Drew PJ, Heer K, Imrie MJ, Fox JN, Carleton PJ, Monson JRT, Kerin MJ The UniversiQ of Hull Academic Surgical Unit Screen detected suspicious or malignant mammographic abnormalities have traditionally been managed by wire localisation and excision. This has associated morbidity due to the need for general anaesthesia, excision of significant amount of benign breast tissue and the requirement for multiple procedures in some patients. W e present our initial experience with a new system (ABBI, Autosuture. USS Surgical), used for core biopsy, diagnostic and therapeutic procedures in patients with screen detected mammographic abnormalities. All procedures were done under local anaesthesia as day cases. Twenty four patients with screen detected abnormalities were evaluated with the system. Five (5) patients underwent an ABBI excision biopsy for invasive ductal carcinoma (3) ductal carcinoma in situ (1) and complex sclerosing lesion (1). Mean duration for the procedures was 90 minutes (75.105). The size of the invasive cancers ranged from 8-13 mm. All patients with carcinoma have had wide excision following their ABBI
225
excision, although no further carcinoma was found in 2 cases. All have been node negative. Core biopsies were performed on 19 patients. Histology revealed 13 benign lesions, 5 DCIS and I invasive ductal carcinoma. The patients with DCIS and invasive carcinoma subsequently underwent further definitive surgery. The mean duration of these procedures was 15 minutes (13-I 7). This is the first report of the utilisation of this new system in conjunction with a screening programme. It is a well tolerated minimally invasive procedure and as such offers significant potential advantages over conventional techniques.
O-3. Prognostic impact of tumour cell detection in patients with early (Tl) and locally advanced breast cancer Die1 IJ Solomayer EF, Gollan Ch, Wallwiener D, Hasfert G Department of Ob/Gyn, University of Heidelberg, Voss-Str 9, Germany lmmunocytochemical detection of tumour cells in bone marrow (TCD) is a marker of tumour dissemination, like axillary nodal status. Therefore TCD could replace nodal status in some subgroups of patients. In a prospective study (1985-96) the intraoperatively aspirated bone marrow of 582 Tl patients and 174 patients with locally advanced disease were screened for micrometastatic cells. W e used the monoclonal mucin-AB 2Ell (reactive with TAG 12) for tumour cell detection. After a median period of 52 months follow-up results were statistically analyzed. 232 of 582 Tl-patients were TCD-positive (39.8%). Distant metastases were found in 50 women. This subgroup displayed a 78% TC-detection rate, although only 44% of them have been nodal positive. In a Cox regression model TCD was the best prognostic factor for disease-free survival (P < 0.001; RR = 8.44). All 174 patients with tumours larger than 3 c m received neoadjuvant chemotherapy (nCHT); whereas 174 matched patients with adjuvant CHT served as controls. In the matched pair analysis 51.7% of the patients had tumour cells in bone marrow after nCHT compared to 49.4% of the controls. Distant metastases were diagnosed in 27 patients (24 were TCD+). The Cox model confirmed TCD as the best prognostic factor in both groups. In 42 women bone marrow aspiration before and after nCHT was performed. The rate of TCD were unchanged before and after nCHT (n = 22; 52.3%). Only in 4 patients the findings changed (2 from pos. in neg. and 2 viceversa). As previously shown, tumour cell detection in bone marrow is an outstanding prognostic factor in breast cancer (JNCI, 1996, 1652). In the present analysis we could confirm this data in patients with small and locally advanced turnours. In some subgroups TCD could be an alternative to axillary dissection; or complete established prognostic markers.
ABSTRACTS
5th Nottingham International Breast Cancer Conference 17-19 September 1997
O-l. Lymphoscintigraphy for locating the sentinel lymph node in patients with breast cancer Gill PG, Hall VE, Kirkwood I, Chatterton BE, Coventry B, Vernon-Roberts E Breast Unit, Royal Adelaide Hospital, South Australia A prospective study was undertaken to locate sentinel nodes (SN) (first draining LN) using lymphoscintigraphy (LS) and peritumoural blue dye (BD) injection at surgery in patients with breast carcinoma, and determine the accuracy of SN status in staging the axilla. 36 female patients with breast carcinoma underwent LS using yymTc labelled antimony sulphide colloid (99mTc-Sb2S3)prior to surgery. The radionuclide was injected at the tumour margin. A skin marking overlying the SN was made. The BD technique was replaced by intraoperative gamma probe for intraoperative SN localisation. The SN was resected and pathological assessment of the SN obtained. Axillary SN were identified in 30/36 (83%) of patients. The SN status predicted the axillary LN status in 28/30 (93%). There were 2 false negative cases (false negative - 8.3%). Our results suggest that LS, BD and intraoperative gamma probe allow localisation of SN. The SN status is a good predictor of the axillary LN status.
O-2. New approach to therapeutic and diagnostic management of screen detected mammographic abnormalities: the ABBI system Menon M, Drew PJ, Heer K, Imrie MJ, Fox JN, Carleton PJ, Monson JRT, Kerin MJ The UniversiQ of Hull Academic Surgical Unit Screen detected suspicious or malignant mammographic abnormalities have traditionally been managed by wire localisation and excision. This has associated morbidity due to the need for general anaesthesia, excision of significant amount of benign breast tissue and the requirement for multiple procedures in some patients. W e present our initial experience with a new system (ABBI, Autosuture. USS Surgical), used for core biopsy, diagnostic and therapeutic procedures in patients with screen detected mammographic abnormalities. All procedures were done under local anaesthesia as day cases. Twenty four patients with screen detected abnormalities were evaluated with the system. Five (5) patients underwent an ABBI excision biopsy for invasive ductal carcinoma (3) ductal carcinoma in situ (1) and complex sclerosing lesion (1). Mean duration for the procedures was 90 minutes (75.105). The size of the invasive cancers ranged from 8-13 mm. All patients with carcinoma have had wide excision following their ABBI
225
excision, although no further carcinoma was found in 2 cases. All have been node negative. Core biopsies were performed on 19 patients. Histology revealed 13 benign lesions, 5 DCIS and I invasive ductal carcinoma. The patients with DCIS and invasive carcinoma subsequently underwent further definitive surgery. The mean duration of these procedures was 15 minutes (13-I 7). This is the first report of the utilisation of this new system in conjunction with a screening programme. It is a well tolerated minimally invasive procedure and as such offers significant potential advantages over conventional techniques.
O-3. Prognostic impact of tumour cell detection in patients with early (Tl) and locally advanced breast cancer Die1 IJ Solomayer EF, Gollan Ch, Wallwiener D, Hasfert G Department of Ob/Gyn, University of Heidelberg, Voss-Str 9, Germany lmmunocytochemical detection of tumour cells in bone marrow (TCD) is a marker of tumour dissemination, like axillary nodal status. Therefore TCD could replace nodal status in some subgroups of patients. In a prospective study (1985-96) the intraoperatively aspirated bone marrow of 582 Tl patients and 174 patients with locally advanced disease were screened for micrometastatic cells. W e used the monoclonal mucin-AB 2Ell (reactive with TAG 12) for tumour cell detection. After a median period of 52 months follow-up results were statistically analyzed. 232 of 582 Tl-patients were TCD-positive (39.8%). Distant metastases were found in 50 women. This subgroup displayed a 78% TC-detection rate, although only 44% of them have been nodal positive. In a Cox regression model TCD was the best prognostic factor for disease-free survival (P < 0.001; RR = 8.44). All 174 patients with tumours larger than 3 c m received neoadjuvant chemotherapy (nCHT); whereas 174 matched patients with adjuvant CHT served as controls. In the matched pair analysis 51.7% of the patients had tumour cells in bone marrow after nCHT compared to 49.4% of the controls. Distant metastases were diagnosed in 27 patients (24 were TCD+). The Cox model confirmed TCD as the best prognostic factor in both groups. In 42 women bone marrow aspiration before and after nCHT was performed. The rate of TCD were unchanged before and after nCHT (n = 22; 52.3%). Only in 4 patients the findings changed (2 from pos. in neg. and 2 viceversa). As previously shown, tumour cell detection in bone marrow is an outstanding prognostic factor in breast cancer (JNCI, 1996, 1652). In the present analysis we could confirm this data in patients with small and locally advanced turnours. In some subgroups TCD could be an alternative to axillary dissection; or complete established prognostic markers.