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200. Does locally advanced breast cancer differ in Egyptian patients?
S120
ABSTRACTS
Poster Session: Breast Cancer 200. Does locally advanced breast cancer differ in Egyptian patients? F. Abou El-Kasem1, M. Abdel-Hafez1, H. Gamal2, A. Abdul-Rahman3 1 National Cancer Institute Cairo University Egypt, Medical Oncology Department, Cairo, Egypt 2 National Cancer Institute Cairo University Egypt, Surgical Oncology Department, Cairo, Egypt 3 National Cancer Institute Cairo University Egypt, Biostatistics and Cancer Epidemiology Department, Cairo, Egypt Background: Women with locally advanced breast cancer (LABC) who are breast conservation (BCT) candidates after neoadjuvant chemotherapy have the best long-term outcome and low local-regional recurrence (LRR) rates. However, young women are thought to have a higher risk of LRR based on historical data. Study objective: A cancer registry was analyzed to determine the clinicopathologic characteristics affecting 118 locally advanced breast cancer referred to National Cancer Institute, Cairo University , Egypt from 2010 to 2014. Material and methods: Retrospective review of patients with locally advanced breast cancer (LABC) presented to National Cancer Institute, Cairo University, Egypt; diagnosed between 2010 and 2014. Detailed clinical, surgical and pathological data were obtained from all patients. Pearson’s chi(2) and Fisher’s Exact tests were used for statistical analysis. Results: There were 118 cases of LABC referred to our Institute during this period 2010 and 2014. We found a statistical significant relationship between young age group (40) and hormonal treatment (p ¼ 0.03). Also, there was a statistical significant relationship between triple negative cases and local recurrence (p ¼ 0.001). Our patients’ age ranged from 25 to 75 years with median ¼ 50.5 years. Eighty-eight (75.9%) cases received neoadjuvant chemotherapy. Seventy-four (66.1%) cases received adjuvant treatment. Fourty-two (38.2%) cases had >3 positive lymph nodes. Eightyone (71.7%) cases underwent MRM. Only, 5 (4.3%) cases were of ILC pathological type. T3 was identified in 53 (44.5%) cases. Grade 2 of differentiation was proved in 113 (95%) cases. Ninetytwo (77.3%) cases were ER positive. Eighty-one (68.1%) cases were PR positive. Eightyeight (73.9%) cases were HER2/neu positive. Seventy-nine (66.4%) cases received adjuvant radiotherapy. Conclusions: There is statistical significant correlation between young age group (40) and hormonal treatment (p ¼ 0.03). Also, there was a statistical significant relationship between triple negative cases and local recurrence (p ¼ 0.000). Adequate aggressive treatment is recommended for young breast cancer patients. Adjuvant radiotherapy for triple negative breast cancer patients is recommended to avoid local recurrence. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.133
201. A voice for sentinel node biopsy at the time of breast surgery for non-palpable but mass-forming pure DCIS found on image-guided breast biopsy B. Szynglarewicz, P. Kasprzak, A. Maciejczyk, T. Michalik, B. Oleszkiewicz, M. Strychalska, R. Matkowski Lower Silesia Oncology Centre e Regional Comprehensive Cancer Centre, Breast Unit, Wroclaw, Poland Background: In the era of screening programmes breast ductal carcinoma in situ (DCIS) is diagnosed more and more often, usually as mammographic microcalcifications. Asymmetric density, architectural distortion, or radiological mass are less common. The aim of this study was to assess the risk of postoperative upgrading to invasive cancer in cases of pure DCIS presenting as non-palpable mammographic mass.
Material and methods: We studied thirty-five consecutive patients treated in years 2004e2015 due to pure DCIS found on minimal-invasive image-guided biopsy (core-needle or vacuum-assisted) of non-palpable mammographic mass. When appropriate median, mean, standard deviation and range were calculated. Patients without upgraded DCIS were compared to those with postoperative upgrading to invasive cancer using Student T-test for continuous variables and chi-square test for categorical features. P-value less than 0.05 was considered statistically significant. Results: Median patient age and lesion size (mean, SD, range) was 65 years (64.5, 11.3, 30e87) and 9 mm (9.0, 1.9, 6e14), respectively. Postoperative invasion was found in 14 patients giving 40% upgrading rate. Patients with upgraded DCIS were significantly younger (66.1 vs 70.7 years, P ¼ 0.007). They had slightly, but not significantly, larger lesions (9.6 vs 8.8 mm, P ¼ 0.244). More than one-third of DCIS with diameter equal or smaller than 10 mm were upgraded and more than half of larger lesions: 36% and 57%, respectively. However, the difference was not significant (P ¼ 0.300), which means that DCIS forming even a small mass is a high risk lesion with regard to the presence of invasive component in postoperative specimen. Conclusions: Pure DCIS diagnosed on image-guided biopsy of nonpalpable mammographic mass is associated with important risk of the presence of invasion in surgical specimen. Thus, one-step operation that includes sentinel node biopsy is worth to be taken into account. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.134
202. An oncoplastic approach to central breast tumours B. Szynglarewicz, T. Michalik, B. Oleszkiewicz, R. Matkowski Lower Silesia Oncology Centre e Regional Comprehensive Cancer Centre, Breast Unit, Wroclaw, Poland Background: Oncoplastic approach to breast cancer allows oncologically adequate tumour excision without compromising cosmetic results. However, in cases of central breast tumours to achieve these goals both remains commonly a surgical challenge. Material and methods: Thirty-four patients operated on due to central breast tumour (malignant or benign) in the year 2014 were studied. Series covered retroareolar lesions and cases when the distance between tumour and nipple-areola complex (NAC) was up to 2 cm. Two women were not enrolled into the analysis because of the primary NAC excision with delayed reconstruction (Huemer technique). Remaining thirty-two patients underwent surgical excision after skin markings and hook-wire localisation in non-palpable tumours. Various oncoplastic techniques were used to fill the tissue defect, reshape the breast, and relocate the nipple-areola complex, if needed. Cosmetic outcome was assessed 4 weeks after surgery by the patient herself and rated as good, medium, or poor. Results: Oncoplastic techniques included: superior pedicle technique (Pitanguy 4, Lassus & Lejour 1), inferior pedicle (2), batwing mammoplasty (7), V-mammoplasty: (2), J-mammoplasty (4), racquet mammoplasty (2), medial pedicle (Hall-Findlay 2), round-block technique (Benelli 5), Grisotti flap (2), vertical bi-pedicle technique (Pers & Bretteville-Jensen 1). In one patient wound haematoma requiring revision happened. In two women partial epidermal necrosis of areola developed (superior pedicle and round-block), successfully healed per secundam in both cases. In two other patients re-excision was needed because of positive or close margin. After four weeks from surgery cosmesis was assessed as poor in none of the cases. Cosmetic outcome was evaluated as good and medium in 30 (94%) and 2 (6%) cases, respectively. One patient with result rated as other than good determined a scar formation as a main
ABSTRACTS
Poster Session: Breast Cancer 200. Does locally advanced breast cancer differ in Egyptian patients? F. Abou El-Kasem1, M. Abdel-Hafez1, H. Gamal2, A. Abdul-Rahman3 1 National Cancer Institute Cairo University Egypt, Medical Oncology Department, Cairo, Egypt 2 National Cancer Institute Cairo University Egypt, Surgical Oncology Department, Cairo, Egypt 3 National Cancer Institute Cairo University Egypt, Biostatistics and Cancer Epidemiology Department, Cairo, Egypt Background: Women with locally advanced breast cancer (LABC) who are breast conservation (BCT) candidates after neoadjuvant chemotherapy have the best long-term outcome and low local-regional recurrence (LRR) rates. However, young women are thought to have a higher risk of LRR based on historical data. Study objective: A cancer registry was analyzed to determine the clinicopathologic characteristics affecting 118 locally advanced breast cancer referred to National Cancer Institute, Cairo University , Egypt from 2010 to 2014. Material and methods: Retrospective review of patients with locally advanced breast cancer (LABC) presented to National Cancer Institute, Cairo University, Egypt; diagnosed between 2010 and 2014. Detailed clinical, surgical and pathological data were obtained from all patients. Pearson’s chi(2) and Fisher’s Exact tests were used for statistical analysis. Results: There were 118 cases of LABC referred to our Institute during this period 2010 and 2014. We found a statistical significant relationship between young age group (40) and hormonal treatment (p ¼ 0.03). Also, there was a statistical significant relationship between triple negative cases and local recurrence (p ¼ 0.001). Our patients’ age ranged from 25 to 75 years with median ¼ 50.5 years. Eighty-eight (75.9%) cases received neoadjuvant chemotherapy. Seventy-four (66.1%) cases received adjuvant treatment. Fourty-two (38.2%) cases had >3 positive lymph nodes. Eightyone (71.7%) cases underwent MRM. Only, 5 (4.3%) cases were of ILC pathological type. T3 was identified in 53 (44.5%) cases. Grade 2 of differentiation was proved in 113 (95%) cases. Ninetytwo (77.3%) cases were ER positive. Eighty-one (68.1%) cases were PR positive. Eightyeight (73.9%) cases were HER2/neu positive. Seventy-nine (66.4%) cases received adjuvant radiotherapy. Conclusions: There is statistical significant correlation between young age group (40) and hormonal treatment (p ¼ 0.03). Also, there was a statistical significant relationship between triple negative cases and local recurrence (p ¼ 0.000). Adequate aggressive treatment is recommended for young breast cancer patients. Adjuvant radiotherapy for triple negative breast cancer patients is recommended to avoid local recurrence. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.133
201. A voice for sentinel node biopsy at the time of breast surgery for non-palpable but mass-forming pure DCIS found on image-guided breast biopsy B. Szynglarewicz, P. Kasprzak, A. Maciejczyk, T. Michalik, B. Oleszkiewicz, M. Strychalska, R. Matkowski Lower Silesia Oncology Centre e Regional Comprehensive Cancer Centre, Breast Unit, Wroclaw, Poland Background: In the era of screening programmes breast ductal carcinoma in situ (DCIS) is diagnosed more and more often, usually as mammographic microcalcifications. Asymmetric density, architectural distortion, or radiological mass are less common. The aim of this study was to assess the risk of postoperative upgrading to invasive cancer in cases of pure DCIS presenting as non-palpable mammographic mass.
Material and methods: We studied thirty-five consecutive patients treated in years 2004e2015 due to pure DCIS found on minimal-invasive image-guided biopsy (core-needle or vacuum-assisted) of non-palpable mammographic mass. When appropriate median, mean, standard deviation and range were calculated. Patients without upgraded DCIS were compared to those with postoperative upgrading to invasive cancer using Student T-test for continuous variables and chi-square test for categorical features. P-value less than 0.05 was considered statistically significant. Results: Median patient age and lesion size (mean, SD, range) was 65 years (64.5, 11.3, 30e87) and 9 mm (9.0, 1.9, 6e14), respectively. Postoperative invasion was found in 14 patients giving 40% upgrading rate. Patients with upgraded DCIS were significantly younger (66.1 vs 70.7 years, P ¼ 0.007). They had slightly, but not significantly, larger lesions (9.6 vs 8.8 mm, P ¼ 0.244). More than one-third of DCIS with diameter equal or smaller than 10 mm were upgraded and more than half of larger lesions: 36% and 57%, respectively. However, the difference was not significant (P ¼ 0.300), which means that DCIS forming even a small mass is a high risk lesion with regard to the presence of invasive component in postoperative specimen. Conclusions: Pure DCIS diagnosed on image-guided biopsy of nonpalpable mammographic mass is associated with important risk of the presence of invasion in surgical specimen. Thus, one-step operation that includes sentinel node biopsy is worth to be taken into account. Conflict of interest: No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2016.06.134
202. An oncoplastic approach to central breast tumours B. Szynglarewicz, T. Michalik, B. Oleszkiewicz, R. Matkowski Lower Silesia Oncology Centre e Regional Comprehensive Cancer Centre, Breast Unit, Wroclaw, Poland Background: Oncoplastic approach to breast cancer allows oncologically adequate tumour excision without compromising cosmetic results. However, in cases of central breast tumours to achieve these goals both remains commonly a surgical challenge. Material and methods: Thirty-four patients operated on due to central breast tumour (malignant or benign) in the year 2014 were studied. Series covered retroareolar lesions and cases when the distance between tumour and nipple-areola complex (NAC) was up to 2 cm. Two women were not enrolled into the analysis because of the primary NAC excision with delayed reconstruction (Huemer technique). Remaining thirty-two patients underwent surgical excision after skin markings and hook-wire localisation in non-palpable tumours. Various oncoplastic techniques were used to fill the tissue defect, reshape the breast, and relocate the nipple-areola complex, if needed. Cosmetic outcome was assessed 4 weeks after surgery by the patient herself and rated as good, medium, or poor. Results: Oncoplastic techniques included: superior pedicle technique (Pitanguy 4, Lassus & Lejour 1), inferior pedicle (2), batwing mammoplasty (7), V-mammoplasty: (2), J-mammoplasty (4), racquet mammoplasty (2), medial pedicle (Hall-Findlay 2), round-block technique (Benelli 5), Grisotti flap (2), vertical bi-pedicle technique (Pers & Bretteville-Jensen 1). In one patient wound haematoma requiring revision happened. In two women partial epidermal necrosis of areola developed (superior pedicle and round-block), successfully healed per secundam in both cases. In two other patients re-excision was needed because of positive or close margin. After four weeks from surgery cosmesis was assessed as poor in none of the cases. Cosmetic outcome was evaluated as good and medium in 30 (94%) and 2 (6%) cases, respectively. One patient with result rated as other than good determined a scar formation as a main