- Email: [email protected]
0103 Ductal breast carcinomas: Residual tumor rate in re-excisions after breast conserving surgery
S44
Poster Session I. Surgery/Sentinels/DCIS
Methods: We retrospectively analyzed 788 patients, median age 51 years, with primary breast cancer who underwent NSM from 1985 to 2004. The indication of NSM in this study was defined as being for any stage, any tumor size and any tumor–areola distance. Briefly, NAC was preserved when palpation and the outlook of the nipple was normal. Median tumor size and tumor–areola distance were 2.5 cm (0−10.0) and 1.8 cm (0−9.0), respectively. Our surgical notes for NSM were; (1) a thin flap (approximately 5 mm thick subcutaneous adipose tissue) was placed close to the tumor, and a thick flap (more than 1 cm thick subcutaneous adipose tissue) was created more than 2 cm away from the tumor to conserve breast volume using subcutaneous fat, and (2) tissue under the NAC was left at 5 mm in thickness, but the major ducts were removed from within its lumen. Eightyone patients (10%) underwent immediate breast reconstruction (IBR) using implants. We also analyzed 144 patients with breast cancer who underwent MT in the same period as those who underwent NSM. No patient received radiotherapy. We compared the local recurrence rate (LRR), disease-free survival (DFS) and overall survival (OS) between 788 NSM and 144 MT cases. Results: Median follow-up of NSM and MT was 92 (10–252) and 87 (0–231) months, respectively. To our surprise, no complications of NSM including nipple and areola necrosis were recorded (0/788). For NSM, there were 70 patients (8.9%) with local recurrence, including 23 (2.9%) at the nipple, 4 (0.5%) at the areola, 4 (0.5%) at both nipple and areola, and 39 at the skin flap (4.9%). This suggested that the rate of NAC relapse was quite low. There were no significant differences in LLR between NSM and MT, (10y, 8.9% vs. 7.6%, p = 0.62), DFS (10y, 83% vs. 83%, p = 0.34) and OS (10y, 88% vs. 86%, p = 0.34), respectively. Cosmetic outcome of NSM was better than that of MT in the majority of patients. Conclusion: These results suggested that NSM provides a good cosmetic outcome and is as safe oncologically as MT. Our long term follow-up data shows that NSM is a possible alternative to mastectomy.
0101
Is BCS always successful?
C.S. Yoon1 , W.N. Kang1 , S.S. Ko1 , M. Hur1 , H.K. Lee1 , S.S. Kang1 . 1 Surgery, Cheil hospital, Kwandong University, College of Medicine, Seoul, South Korea Goals: Breast-conserving surgery (BCS) has been considered a standard treatment for early-stage breast cancer. The purpose of this study was to evaluate the conversion rate from BCS to mastectomy and to compare the clinicopathological characteristics between patients who had a successful BCS and patients who had a conversion from BCS to mastectomy. Methods: We reviewed our institution’s data treating 947 patients with breast cancer with BCS or BCS attempted mastectomy from Jan. 2000 to Dec. 2004. Of 947 patients, BCS was attempted for 293 patients, 49 patients (16.7%) of 293 BCS attempts converted to mastectomy and the remaining 654 patients underwent mastectomy. Data were collected regarding tumor size, lymph node status, histologic grade, nuclear grade, invasive type, age, lymphovascular invasion, ER, PR, Hercep status, extensive intraductal component (EIC). Univariate analysis for the differences between the two groups was tested using the Pearson’s chi-square test; Multivariate analysis was based on a logistic regression between the two groups. Results: Univariate analysis showed that type of surgery was associated with tumor size, EIC, ER status (p < 0.001). Patients with tumor 2 cm had breast conservation rates of 89.4% while compared with 77% for tumor 2−5 cm, 37.5% for tumor >5 cm (p < 0.001). Patients with EIC negative and positive also underwent breast-conserving surgery 92.9% and 71.7% (p < 0.001). Patients with ER negative were more likely to undergo BCS (91%) than those who were not (80%, p = 0.02). Using Multivariate analysis several variables (tumor size, EIC, ER status) studied remained predictors of BCS. Patients with tumor 2 cm were 14.0 times (95 CI, 3.10−63.86, p < 0.0001) more likely to undergo BCS than patients with tumor >5 cm. Patients with EIC negative were 5.1 times (95 CI, 2.06−12.71, p < 0.0001) more likely to undergo BCS than patients with EIC positive. Patients with ER negative were 2.5 times (95 CI, 1.13−5.66, p = 0.021) more likely to undergo BCS than patients who were not. Conclusion: As anticipated, tumor size and EIC were strong predictors of the type of surgery. Other than mammography and ultrasonography, more accurate measurements on tumor size should be necessary. Also,
Thursday, 12 March 2009 more precise pathologic information about EIC in initial diagnosis using needle biopsy, excision, etc. could affect the success rate of BCS.
0102
Isotope-guided surgery for non-palpable breast cancer in Chinese women
W.K. Hung1 , M.P. Chow1 , M.W.L. Ying1 , C.Y. Lui2 , M.C.M. Chan1 , K.L. Mak3 . 1 Surgery, 2 Radiology, 3 Pathology, Kwong Wah Hospital, Hong Kong, Hong Kong Special Administrative Region of China Goals: The aim of this study was to evaluate the role of isotope in the management of non-palpable cancer in Chinese women. Methods: Sentinel Node & Occult Lesion Localization (SNOLL) was employed as the operative technique for breast-conserving surgery for nonpalpable breast cancer. Stereotactic or ultrasound guided intratumoral injection of 99mTc-labeled colloid and lymphoscintigraphy were performed preoperatively. Gamma probe was used intraoperatively for resection planning and localization of sentinel lymph node (SLN). Frozen section was performed on the SLN and axillary dissection was performed if nodal metastasis was detected. Complete excision was defined as tumour free margin of greater than 1 mm. Results: Forty patients underwent SNOLL from 2003 to 2007. Index lesion was successfully removed in all patients. 14 patients (35%) had DCIS while 26 patients (65%) had invasive carcinoma. Complete excision was achieved in 33 patients (82.5%). Only 6 patients required second operation for achieving margin free status. Hot spots in axilla were detected by lymphoscintigraphy in 29 patients (72.5%). For patients with negative lymphoscintigraphy, supplementary blue dye mapping increased the SLN localization rate from 22% to 89%. SLN identification rate was 92.5% for the whole series. Two patients had SLN metastasis and axillary dissection was performed in the same operation. Conclusion: SNOLL is a promising technique in treating clinically occult breast cancer. It offers excellent guidance in localization of index lesion and planning of resection extent. Supplementary blue dye mapping improve the success of SLN localization especially in patients with negative lymphoscintigraphy.
0103
Ductal breast carcinomas: Residual tumor rate in re-excisions after breast conserving surgery
1 , C. Sanz1 , R. Noguero1 , M. Gallego1 , L. Arroyo1 , B. Sancho Perez ´ 1 . 1 Obstetrics and gynaecology, Hospital ´ S. Aragon ´ 1 , J.M. Hernandez Universitario 12 de Octubre, Madrid, Spain
Goals: The final goal in breast conserving surgery on early stages of breast cancer should be to obtain free margins, but not in every marginaffected biopsy is residual carcinoma found. We analyzed histological and immunohistochemical (IHC) characteristics of ductal carcinomas, in order to know which of them could correlate with the existence of residual tumor in re-excisions. Methods: We retrospectively analyzed 475 consecutive ductal carcinomas, diagnosed during years 2003–2006 (15.9% in situ, 1.9% microinvasive and 82.2% invasive ductal carcinomas). “Free” margins were considered with tumoral cells 3 mm or farther from surgery border, “close” with tumoral cells less 3 mm away and “affected” margins with tumoral cells on borders. In re-excisioned carcinomas, we considered “positive” re-excisions, those with residual tumor. Results: 62.4% of breast conserving surgery in ductal carcinomas needed re-excision for close or affected margins (56.8% of ductal carcinomas in situ (DCIS) and 50% of invasive ductal carcinomas (IDC) had “positive” re-excision result). In IDC we found more residual tumour rate on re-excisions (p = 0.03) in those with initially affected margins (57%) than in those with close margins (35%), size greater than 20 mm (p = 0.005), axillary lymph node involvement (p = 0.007), Cerb B2 over-expression (p = 0.002), positive p53 (p = 0.003) and proliferative index (MIB 1) over 30%. In DCIS we found no statistical difference (p = 0.13) for re-excision results dependent if margins were initially “close” (45%) or “affected” (65%) and histological higher grades (II and III) were related with greater “positive” re-excision rates (64.7%) (p = 0.005) than histological grade I (30%). A second re-excision for persistently affected margins on first re-excision (3 surgeries), was necessary in 11% of DCIS but only in 2% of IDC.
Thursday, 12 March 2009 Conclusion: Free margins are not enough in ductal carcinomas for a safe oncologic resection, and in those in which a margin of more than 3 mm from the surgical border have not been achieved after a first surgery, re-excision is recommended specially for patients with histological grades II and III in DCIS, and in IDC those greater than 20 mm, positive axillary lymph node involvement and adverse IHC factors (Cerb B2 overexpression, positive p53, and proliferative index MIB 1 over 30%), regardless other characteristics. Clear margins in DCIS are some times difficult to obtain after a first re-excision.
0104
Is surgical excision necessary for benign phyllodes tumor of the breast diagnosed and excised by ultrasound-guided vacuum assisted biopsy device (Mammotome)?
H. Park1 , J. Song2 . 1 Surgery, Pochon Cha University College of Medicine, 2 Surgery, Kyung Hee University College of Medicine, Seoul, South Korea Goals: Phyllodes tumors are characterized by a double layered epithelial component arranged in cleflike ducts surrounded by a hypercellular spindle-celled stroma. Currently phyllode tumors are classified as benign, borderline, or malignant based on microscopic features. The relatively high recurrence rate is an unsolved management problem. If malignant phyllodes tumor is treated inadequately it can shows a propensity for rapid growth and metastatic spread. However benign phyllodes tumors are often indistinguishable from fibroadenoma and can be cured by local surgery. Recently percutaneous removal of benign breast tumor using the Mammotome system has been regarded as a feasible, safe method without serious complications. Mammotome system has an expanding role in the surgical treatment of benign breast disease, and may further extend its role to the excision of small malignant lesions. The aim of this study was to evaluate the efficacy and the safety of Mammotome biopsy device in the treatment of benign phyllodes tumor and to identify if surgical excision is necessary for benign phyllodes tumor diagnosed and excised by Mammotome. Methods: From Jan. 2003 to Feb. 2007, a total of 2751 US-guided mammotome excision were performed in 2226 patients at Kangnam Cha hospital. Out of 2751 lesions, 30 lesions were proved to be benign phyllodes tumor. All lesions were removed by 8 gauge probe without any residual lesion. Ultrasonographic follow-up were performed on 3−6 months interval to assess recurrences. Mean follow up period was 33.2 months (max 51 months, min 2 months). Results: Mean patient age was 31.4 years. The average size of lesion was 1.5 cm (SD ±0.43 cm). The majority of lesions, 73.3% (22 cases), were palpable and 26.7% (8 cases) were nonpalpable. 22 lesions (73.8%) were classified as BIRADS category 3, 8 lesions (26.7%) were classified as category 4A by ultrasound. During follow up period local recurrence developed in only 1 patient, local recurrence rate was 3.3%. And there were no distant metastasis. Conclusion: Benign phyllodes tumor found on mammotome excision may not need surgical reexcision if surgeons are sure that the targeted lesions were excised completely and the follow up ultrasound does not show any residual lesions, especially in small phyllodes tumors less than 3 cm in greatest dimension.
0105
Is there a promotion of metastasis by autologeous breast reconstruction in patients with invasive breast cancer?
A. Smeets1 , K.K. Van Calster1 , H. Wildiers1 , J.J.P. Lobelle1 , M.M. Vandevoort1 , P. Neven1 , R. Paridaens1 , M.M.R. Christiaens1 . 1 Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium Goals: After a mastectomy for an invasive breast cancer, an autologeous breast reconstruction can be performed. However, there is evidence that surgical interventions might promote metastasis. The goals of our study were 1. To investigate the correlation between autologeous breast reconstruction and the development of metastasis. 2. To compare the incidence of metastasis in patients with an without reconstruction. Methods: First, we included patients with an autologeous breast reconstruction between 2000 and 2004 after a mastectomy for an invasive breast cancer. Patients with a contra-lateral tumor, neo-adjuvant therapy or
Poster Session I. Surgery/Sentinels/DCIS
S45
recurrence before reconstruction were excluded. 99 patients were included with a mean FU of 76 months. Next, the incidence of metastasis in reconstructed patients was compared to a control group without reconstruction. For this analysis, only patients between age 30 and 65 at diagnosis and a mastectomy between 2000 and 2004 were included. Reconstruction had to be performed before 2006. 72 patients were included in the reconstruction group, 375 in the control group. Tumor characteristics are similar in both groups (histology, NPI, ER, HER2/neu). The mean FU is 64 months for the reconstruction group, 57 months for the control group. Results: 14% patients with a reconstruction between 2000 and 2004 developed metastasis. Very surprisingly, 13/14 metastasises were diagnosed within 2 years after reconstruction! 11.1% of patients with a mastectomy between 2000 and 2004 developed metastasis and 10.13% of patients from the control group (p= 0.8025). Conclusion: The finding that 13/14 metastasis after reconstruction were diagnosed within 2 years after reconstruction seems to confirm the hypothesis that surgery can promote metastasis. On the other hand do our data not show an increased incidence of distant metastasis in patients who undergo an autologeous breast reconstruction when compared to a control group. A possible explanation could be that this is a retrospective with only a limited number of recurrences in the reconstructive group. Moreover, all patients with a delayed reconstruction have an initial disease free survival which means that their prognosis should be better than the controls. A prospective registration study could be the next step.
0106
The management of the contralateral breast in breast reconstruction in Korean females
J. Jung1 , J. Lee2 , H. Park1 , J. Yang2 , S. Kim3 , Y. Lee4 . 1 Surgery, 2 Plastic Surgery, Kyungpook National University Hospital, 3 Surgery, Daegu Fatima Hospital, 4 Surgery, Hyosung Medical Center, Daegu, South Korea Goals: The final purpose of post mastectomy reconstruction is a balanced, symmetrical, pleasing appearance for both breasts. When reconstruction is considered, equal importance may be needed to be placed on contralateral breast. If some woman have unattractive breast, which is small, ptotic or huge, remodelling of the contralateral breast may be desirable. Numerous options may be available to the patient depending upon the individual anatomic and oncologic status for symmetrical shape. Surgical options available for the contralateral breast included breast augmentation with implant, mastopexy, and reduction mammoplasty. Methods: All patients who underwent unilateral breast reconstruction at Kyungpook national university hospital from September of 2006 to February of 2008 were included in the study. The methods of reconstruction included transverse rectus abdominis musculocutaneous (TRAM) flap, latissimus dorsi (LD) flap, and implant. Contralateral procedure to achieve symmetry included augmentation, mastopexy, and reduction. Results: A total of 57 patients were evaluated including 45 immediate, and 12 delayed reconstructions. 26 of these patients underwent augmentation (n = 12), mastopexy (n = 11) [vertical (n = 8), periareola (n = 3)] and reduction (n = 3) [wise pattern (n = 2), vertical (n = 1)] of the contralateral breast. The average age was 44.9 years and the follow up interval was 7 months (poster Table 1). Most of the patients were satisfied with symmetry, clothed appearance, nude appearance, aesthetics, and consistency (poster Table 2). 66% (8/12) of delayed reconstruction had symmetry procedure performed on opposite breast, compared with 40% (18/45) for the immediate-reconstruction patients. There were 6 fat necrosises, one partial flap loss, and one hernia in TRAM and LD flap reconstruction. Two capsular contractures and one skin necrosis at the junction of the inverted ‘T’ closure flaps were observed in implant reconstruction. However, no complications were observed on contralateral breasts underwent symmetrization. Conclusion: Contralateral management in breast reconstruction can provide symmetry with the reconstructed breast contour and aesthetically satisfactory result with safe. Immediate symmetrization procedure also can avoid secondary operation and offer psychological benefit.
Poster Session I. Surgery/Sentinels/DCIS
Methods: We retrospectively analyzed 788 patients, median age 51 years, with primary breast cancer who underwent NSM from 1985 to 2004. The indication of NSM in this study was defined as being for any stage, any tumor size and any tumor–areola distance. Briefly, NAC was preserved when palpation and the outlook of the nipple was normal. Median tumor size and tumor–areola distance were 2.5 cm (0−10.0) and 1.8 cm (0−9.0), respectively. Our surgical notes for NSM were; (1) a thin flap (approximately 5 mm thick subcutaneous adipose tissue) was placed close to the tumor, and a thick flap (more than 1 cm thick subcutaneous adipose tissue) was created more than 2 cm away from the tumor to conserve breast volume using subcutaneous fat, and (2) tissue under the NAC was left at 5 mm in thickness, but the major ducts were removed from within its lumen. Eightyone patients (10%) underwent immediate breast reconstruction (IBR) using implants. We also analyzed 144 patients with breast cancer who underwent MT in the same period as those who underwent NSM. No patient received radiotherapy. We compared the local recurrence rate (LRR), disease-free survival (DFS) and overall survival (OS) between 788 NSM and 144 MT cases. Results: Median follow-up of NSM and MT was 92 (10–252) and 87 (0–231) months, respectively. To our surprise, no complications of NSM including nipple and areola necrosis were recorded (0/788). For NSM, there were 70 patients (8.9%) with local recurrence, including 23 (2.9%) at the nipple, 4 (0.5%) at the areola, 4 (0.5%) at both nipple and areola, and 39 at the skin flap (4.9%). This suggested that the rate of NAC relapse was quite low. There were no significant differences in LLR between NSM and MT, (10y, 8.9% vs. 7.6%, p = 0.62), DFS (10y, 83% vs. 83%, p = 0.34) and OS (10y, 88% vs. 86%, p = 0.34), respectively. Cosmetic outcome of NSM was better than that of MT in the majority of patients. Conclusion: These results suggested that NSM provides a good cosmetic outcome and is as safe oncologically as MT. Our long term follow-up data shows that NSM is a possible alternative to mastectomy.
0101
Is BCS always successful?
C.S. Yoon1 , W.N. Kang1 , S.S. Ko1 , M. Hur1 , H.K. Lee1 , S.S. Kang1 . 1 Surgery, Cheil hospital, Kwandong University, College of Medicine, Seoul, South Korea Goals: Breast-conserving surgery (BCS) has been considered a standard treatment for early-stage breast cancer. The purpose of this study was to evaluate the conversion rate from BCS to mastectomy and to compare the clinicopathological characteristics between patients who had a successful BCS and patients who had a conversion from BCS to mastectomy. Methods: We reviewed our institution’s data treating 947 patients with breast cancer with BCS or BCS attempted mastectomy from Jan. 2000 to Dec. 2004. Of 947 patients, BCS was attempted for 293 patients, 49 patients (16.7%) of 293 BCS attempts converted to mastectomy and the remaining 654 patients underwent mastectomy. Data were collected regarding tumor size, lymph node status, histologic grade, nuclear grade, invasive type, age, lymphovascular invasion, ER, PR, Hercep status, extensive intraductal component (EIC). Univariate analysis for the differences between the two groups was tested using the Pearson’s chi-square test; Multivariate analysis was based on a logistic regression between the two groups. Results: Univariate analysis showed that type of surgery was associated with tumor size, EIC, ER status (p < 0.001). Patients with tumor 2 cm had breast conservation rates of 89.4% while compared with 77% for tumor 2−5 cm, 37.5% for tumor >5 cm (p < 0.001). Patients with EIC negative and positive also underwent breast-conserving surgery 92.9% and 71.7% (p < 0.001). Patients with ER negative were more likely to undergo BCS (91%) than those who were not (80%, p = 0.02). Using Multivariate analysis several variables (tumor size, EIC, ER status) studied remained predictors of BCS. Patients with tumor 2 cm were 14.0 times (95 CI, 3.10−63.86, p < 0.0001) more likely to undergo BCS than patients with tumor >5 cm. Patients with EIC negative were 5.1 times (95 CI, 2.06−12.71, p < 0.0001) more likely to undergo BCS than patients with EIC positive. Patients with ER negative were 2.5 times (95 CI, 1.13−5.66, p = 0.021) more likely to undergo BCS than patients who were not. Conclusion: As anticipated, tumor size and EIC were strong predictors of the type of surgery. Other than mammography and ultrasonography, more accurate measurements on tumor size should be necessary. Also,
Thursday, 12 March 2009 more precise pathologic information about EIC in initial diagnosis using needle biopsy, excision, etc. could affect the success rate of BCS.
0102
Isotope-guided surgery for non-palpable breast cancer in Chinese women
W.K. Hung1 , M.P. Chow1 , M.W.L. Ying1 , C.Y. Lui2 , M.C.M. Chan1 , K.L. Mak3 . 1 Surgery, 2 Radiology, 3 Pathology, Kwong Wah Hospital, Hong Kong, Hong Kong Special Administrative Region of China Goals: The aim of this study was to evaluate the role of isotope in the management of non-palpable cancer in Chinese women. Methods: Sentinel Node & Occult Lesion Localization (SNOLL) was employed as the operative technique for breast-conserving surgery for nonpalpable breast cancer. Stereotactic or ultrasound guided intratumoral injection of 99mTc-labeled colloid and lymphoscintigraphy were performed preoperatively. Gamma probe was used intraoperatively for resection planning and localization of sentinel lymph node (SLN). Frozen section was performed on the SLN and axillary dissection was performed if nodal metastasis was detected. Complete excision was defined as tumour free margin of greater than 1 mm. Results: Forty patients underwent SNOLL from 2003 to 2007. Index lesion was successfully removed in all patients. 14 patients (35%) had DCIS while 26 patients (65%) had invasive carcinoma. Complete excision was achieved in 33 patients (82.5%). Only 6 patients required second operation for achieving margin free status. Hot spots in axilla were detected by lymphoscintigraphy in 29 patients (72.5%). For patients with negative lymphoscintigraphy, supplementary blue dye mapping increased the SLN localization rate from 22% to 89%. SLN identification rate was 92.5% for the whole series. Two patients had SLN metastasis and axillary dissection was performed in the same operation. Conclusion: SNOLL is a promising technique in treating clinically occult breast cancer. It offers excellent guidance in localization of index lesion and planning of resection extent. Supplementary blue dye mapping improve the success of SLN localization especially in patients with negative lymphoscintigraphy.
0103
Ductal breast carcinomas: Residual tumor rate in re-excisions after breast conserving surgery
1 , C. Sanz1 , R. Noguero1 , M. Gallego1 , L. Arroyo1 , B. Sancho Perez ´ 1 . 1 Obstetrics and gynaecology, Hospital ´ S. Aragon ´ 1 , J.M. Hernandez Universitario 12 de Octubre, Madrid, Spain
Goals: The final goal in breast conserving surgery on early stages of breast cancer should be to obtain free margins, but not in every marginaffected biopsy is residual carcinoma found. We analyzed histological and immunohistochemical (IHC) characteristics of ductal carcinomas, in order to know which of them could correlate with the existence of residual tumor in re-excisions. Methods: We retrospectively analyzed 475 consecutive ductal carcinomas, diagnosed during years 2003–2006 (15.9% in situ, 1.9% microinvasive and 82.2% invasive ductal carcinomas). “Free” margins were considered with tumoral cells 3 mm or farther from surgery border, “close” with tumoral cells less 3 mm away and “affected” margins with tumoral cells on borders. In re-excisioned carcinomas, we considered “positive” re-excisions, those with residual tumor. Results: 62.4% of breast conserving surgery in ductal carcinomas needed re-excision for close or affected margins (56.8% of ductal carcinomas in situ (DCIS) and 50% of invasive ductal carcinomas (IDC) had “positive” re-excision result). In IDC we found more residual tumour rate on re-excisions (p = 0.03) in those with initially affected margins (57%) than in those with close margins (35%), size greater than 20 mm (p = 0.005), axillary lymph node involvement (p = 0.007), Cerb B2 over-expression (p = 0.002), positive p53 (p = 0.003) and proliferative index (MIB 1) over 30%. In DCIS we found no statistical difference (p = 0.13) for re-excision results dependent if margins were initially “close” (45%) or “affected” (65%) and histological higher grades (II and III) were related with greater “positive” re-excision rates (64.7%) (p = 0.005) than histological grade I (30%). A second re-excision for persistently affected margins on first re-excision (3 surgeries), was necessary in 11% of DCIS but only in 2% of IDC.
Thursday, 12 March 2009 Conclusion: Free margins are not enough in ductal carcinomas for a safe oncologic resection, and in those in which a margin of more than 3 mm from the surgical border have not been achieved after a first surgery, re-excision is recommended specially for patients with histological grades II and III in DCIS, and in IDC those greater than 20 mm, positive axillary lymph node involvement and adverse IHC factors (Cerb B2 overexpression, positive p53, and proliferative index MIB 1 over 30%), regardless other characteristics. Clear margins in DCIS are some times difficult to obtain after a first re-excision.
0104
Is surgical excision necessary for benign phyllodes tumor of the breast diagnosed and excised by ultrasound-guided vacuum assisted biopsy device (Mammotome)?
H. Park1 , J. Song2 . 1 Surgery, Pochon Cha University College of Medicine, 2 Surgery, Kyung Hee University College of Medicine, Seoul, South Korea Goals: Phyllodes tumors are characterized by a double layered epithelial component arranged in cleflike ducts surrounded by a hypercellular spindle-celled stroma. Currently phyllode tumors are classified as benign, borderline, or malignant based on microscopic features. The relatively high recurrence rate is an unsolved management problem. If malignant phyllodes tumor is treated inadequately it can shows a propensity for rapid growth and metastatic spread. However benign phyllodes tumors are often indistinguishable from fibroadenoma and can be cured by local surgery. Recently percutaneous removal of benign breast tumor using the Mammotome system has been regarded as a feasible, safe method without serious complications. Mammotome system has an expanding role in the surgical treatment of benign breast disease, and may further extend its role to the excision of small malignant lesions. The aim of this study was to evaluate the efficacy and the safety of Mammotome biopsy device in the treatment of benign phyllodes tumor and to identify if surgical excision is necessary for benign phyllodes tumor diagnosed and excised by Mammotome. Methods: From Jan. 2003 to Feb. 2007, a total of 2751 US-guided mammotome excision were performed in 2226 patients at Kangnam Cha hospital. Out of 2751 lesions, 30 lesions were proved to be benign phyllodes tumor. All lesions were removed by 8 gauge probe without any residual lesion. Ultrasonographic follow-up were performed on 3−6 months interval to assess recurrences. Mean follow up period was 33.2 months (max 51 months, min 2 months). Results: Mean patient age was 31.4 years. The average size of lesion was 1.5 cm (SD ±0.43 cm). The majority of lesions, 73.3% (22 cases), were palpable and 26.7% (8 cases) were nonpalpable. 22 lesions (73.8%) were classified as BIRADS category 3, 8 lesions (26.7%) were classified as category 4A by ultrasound. During follow up period local recurrence developed in only 1 patient, local recurrence rate was 3.3%. And there were no distant metastasis. Conclusion: Benign phyllodes tumor found on mammotome excision may not need surgical reexcision if surgeons are sure that the targeted lesions were excised completely and the follow up ultrasound does not show any residual lesions, especially in small phyllodes tumors less than 3 cm in greatest dimension.
0105
Is there a promotion of metastasis by autologeous breast reconstruction in patients with invasive breast cancer?
A. Smeets1 , K.K. Van Calster1 , H. Wildiers1 , J.J.P. Lobelle1 , M.M. Vandevoort1 , P. Neven1 , R. Paridaens1 , M.M.R. Christiaens1 . 1 Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium Goals: After a mastectomy for an invasive breast cancer, an autologeous breast reconstruction can be performed. However, there is evidence that surgical interventions might promote metastasis. The goals of our study were 1. To investigate the correlation between autologeous breast reconstruction and the development of metastasis. 2. To compare the incidence of metastasis in patients with an without reconstruction. Methods: First, we included patients with an autologeous breast reconstruction between 2000 and 2004 after a mastectomy for an invasive breast cancer. Patients with a contra-lateral tumor, neo-adjuvant therapy or
Poster Session I. Surgery/Sentinels/DCIS
S45
recurrence before reconstruction were excluded. 99 patients were included with a mean FU of 76 months. Next, the incidence of metastasis in reconstructed patients was compared to a control group without reconstruction. For this analysis, only patients between age 30 and 65 at diagnosis and a mastectomy between 2000 and 2004 were included. Reconstruction had to be performed before 2006. 72 patients were included in the reconstruction group, 375 in the control group. Tumor characteristics are similar in both groups (histology, NPI, ER, HER2/neu). The mean FU is 64 months for the reconstruction group, 57 months for the control group. Results: 14% patients with a reconstruction between 2000 and 2004 developed metastasis. Very surprisingly, 13/14 metastasises were diagnosed within 2 years after reconstruction! 11.1% of patients with a mastectomy between 2000 and 2004 developed metastasis and 10.13% of patients from the control group (p= 0.8025). Conclusion: The finding that 13/14 metastasis after reconstruction were diagnosed within 2 years after reconstruction seems to confirm the hypothesis that surgery can promote metastasis. On the other hand do our data not show an increased incidence of distant metastasis in patients who undergo an autologeous breast reconstruction when compared to a control group. A possible explanation could be that this is a retrospective with only a limited number of recurrences in the reconstructive group. Moreover, all patients with a delayed reconstruction have an initial disease free survival which means that their prognosis should be better than the controls. A prospective registration study could be the next step.
0106
The management of the contralateral breast in breast reconstruction in Korean females
J. Jung1 , J. Lee2 , H. Park1 , J. Yang2 , S. Kim3 , Y. Lee4 . 1 Surgery, 2 Plastic Surgery, Kyungpook National University Hospital, 3 Surgery, Daegu Fatima Hospital, 4 Surgery, Hyosung Medical Center, Daegu, South Korea Goals: The final purpose of post mastectomy reconstruction is a balanced, symmetrical, pleasing appearance for both breasts. When reconstruction is considered, equal importance may be needed to be placed on contralateral breast. If some woman have unattractive breast, which is small, ptotic or huge, remodelling of the contralateral breast may be desirable. Numerous options may be available to the patient depending upon the individual anatomic and oncologic status for symmetrical shape. Surgical options available for the contralateral breast included breast augmentation with implant, mastopexy, and reduction mammoplasty. Methods: All patients who underwent unilateral breast reconstruction at Kyungpook national university hospital from September of 2006 to February of 2008 were included in the study. The methods of reconstruction included transverse rectus abdominis musculocutaneous (TRAM) flap, latissimus dorsi (LD) flap, and implant. Contralateral procedure to achieve symmetry included augmentation, mastopexy, and reduction. Results: A total of 57 patients were evaluated including 45 immediate, and 12 delayed reconstructions. 26 of these patients underwent augmentation (n = 12), mastopexy (n = 11) [vertical (n = 8), periareola (n = 3)] and reduction (n = 3) [wise pattern (n = 2), vertical (n = 1)] of the contralateral breast. The average age was 44.9 years and the follow up interval was 7 months (poster Table 1). Most of the patients were satisfied with symmetry, clothed appearance, nude appearance, aesthetics, and consistency (poster Table 2). 66% (8/12) of delayed reconstruction had symmetry procedure performed on opposite breast, compared with 40% (18/45) for the immediate-reconstruction patients. There were 6 fat necrosises, one partial flap loss, and one hernia in TRAM and LD flap reconstruction. Two capsular contractures and one skin necrosis at the junction of the inverted ‘T’ closure flaps were observed in implant reconstruction. However, no complications were observed on contralateral breasts underwent symmetrization. Conclusion: Contralateral management in breast reconstruction can provide symmetry with the reconstructed breast contour and aesthetically satisfactory result with safe. Immediate symmetrization procedure also can avoid secondary operation and offer psychological benefit.