221. The validity of breast conserving surgery for negative surgical margin – Wide excision versus quadrantectomy

ABSTRACTS 219. Oncological safety of nerve-sparing axillary lymph node dissection M. Kostanyan1, A. Simonyan1 1 National Centre of Oncology, Yerevan, Armenia Background: Management of axilla in patients with operable breast cancer is currently one of the most controversial topics in clinical oncology. Axillary lymph node dissection (ALND) provides crucial staging and prognostic information and possibly an additional therapeutic benefit. Material and methods: We conducted a prospective study to evaluate the number and proportion of involved axillary lymph nodes in two consecutive groups of women who underwent level-2 ALND for operable breast cancer at National Centre of Oncology in the period of 2005-2010 years. In group I (nerve-preserved or experimental group - 110 patients) besides of motor nerves (long thoracic and thoracodorsal nerves) the intercostobrachial nerve (ICBN) was preserved (nerve-sparing or functional ALND). In group II (control, standard or nerve-sacrificed group - 110 patients) the ICBN was transsected (conventional ALND). The ICBN was preserved in the absence of grossly involved nodes. The mean age of the patients was 47.8
12. Patients’ demographic characteristics were alike. The two groups were well balanced for TNM, type of surgery, receptor status. Statistical differences between the groups were calculated using Pearson chi-square test. A P value of < 0.05 was considered statistically significant. Results: The analyses of results showed, that the mean number of dissected (harvested) lymph nodes in both groups were respectively 11.2 and 11.5 (p>0.05). The difference between mean numbers of histologically positive lymph nodes in both groups was also not statistically significant, respectively 1.2 and 1.6. The mean values of metastatic ratios (the proportion between metastatic and examined lymph nodes) in nerve-preserved and control groups were respectively 0.11 and 0.14 (p>0.05). During this period of follow-up, since 2005, there was no evidence of regional recurrence in both groups of patients. Conclusion: Our study demonstrates that the preservation of ICBN does not compromise the efficiency of axillary clearance in breast cancer patients and nerve-sparing ALND is an oncologically safe procedure. 221. The validity of breast conserving surgery for negative surgical margin e Wide excision versus quadrantectomy Y. Koyma1, E. Sakata1, M. Hasegawa1, M. Ikarashi1, N. Manba1, C. Toshikawa1 1 Niigata University School of Medicine, Division of Digestive & General Surgery, Niigata, Japan Background: In breast conserving surgery (BCS) for primary breast cancer, remaining cancer cell may lead to local recurrence, therefore, it is very important to keep clear or negative surgical margins at BCS. Surgical procedure for BCS without oncoplastic technique is divide into 2 procedures; wide excision (Bw) and quadrantectomy (Bq). In the present study, our purpose was to clarify which procedure is valid for negative surgical margins. Materials and Methods: The patients of primary breast cancer, who received BCS at Niigata University Hospital between 2006 and 2010, were entered. Among them, the surgical procedure was decided preoperatively according to the extent of ductal spreading evaluated by the findings of mammography, ultrasonography and magnetic resonance imaging; Bw was selected in the patient with non- or faint ductal spreading, in contrast, the patients with marked ductal spreading were planned to receive Bq. In both procedure, tumor excision was performed with the aim of including the tumor with at least 2cm of healthy tissue far from the macroscopic margins. The clinicopathological factors such as age, disease stage, the distance of surgical margin, the rate of positive margin, and re-excision rate were compared between Bw and Bq. In this study, positive margin was defined as cancer cells existing within 5 mm from the cut surfaces. The statistical analysis was performed by Mann-Whitney U test and Chi-square test, and the statistical significance was defined as p<0.05.

805 Results: Among 359 operations for primary breast cancer during the period, BCS was performed in 173 cases (48.2%), and Bw for 95 cases and Bq for 78 cases. The age of BCS patients was 54 years old in whole cases, and significantly younger in Bq patients compared with Bw patients (p<0.05). The clinical stage distribution analysis showed that Bq was performed for more advanced cases compared with Bw significantly (p<0.05). The distance of surgical margin and the rate of positive margin were not different in the 2 procedures. The re-excision rate was also not different in the 2 procedures. Conclusions: Our study suggests that both wide excision and quadrantectomy are valid for negative surgical margin in BCS. It is important to select BCS procedure according to the preoperative evaluation of tumor extent. 222. Nipple, areola & skin sparing mastectomy: Is it oncologically safe procedure in Egyptian females G. AbouElnagah1, B. ElSabaa2 1 Alexandria Faculty of Medicine, Surgical Oncology Unit General Surgery Departement, Alexandria, Egypt 2 Alexandria Faculty of Medicine, Pathology Departement, Alexandria, Egypt Introduction: Many articles have been published on the safety of skin sparing mastectomy (SSM). Success with skin sparing mastectomy has led to the reconsideration of the necessity to remove the skin overlying the nipple-areola complex. Leaving this area will improve the cosmetic appearance of the reconstructed breast which is the optimal aim of skin sparing mastectomy. The aim of this study is to prove whether or not the Nipple Areola Skin Sparing Mastectomy is oncologically safe in Egyptian females. Methods: This study included 64 cases of operable breast cancer that underwent modified radical mastectomy in the period between January 2010 and December 2010. The excluding criteria were patients who have received chemotherapy and patients who had skin changes involving nipple areola complex. All specimens were subjected to histopathological examination of the subareolar tissue examination searching for malignancy in the subareolar tissue. Patients’ demographics, tumor and histological characteristics were analyzed & correlated with pathological results. Results: In 12 cases (18.8 %), the subareolar tissue was positive for malignancy. Positive predictive value was tumor size >4 cm, distance between tumor and nipple <6 cm (r ¼ 0.05) Conclusion: Nipple areola skin sparing mastectomy appears to be oncologically safe providing that the tumor is small and not close to the nipple and the areola.

223. The eligibility of treating early cancer breast by US-guided radiofrequency ablation in Egyptian females G. AbouElnagah1, S. Elgendy2, M. Elshafey3, A. ElGendy4 1 Alexandria Faculty of Medicine, Surgical Oncology Unit General Surgery Departement, Alexandria, Egypt 2 Alexandria Faculty of Medicine, Pathology Departement, Alexandria, Egypt 3 Alexandria Faculty of Medicine, Radiodiagnosis Departement, Alexandria, Egypt 4 Alexandria Faculty of Medicine, Surgical Departement, Alexandria, Egypt Introduction: This study was designed to determine the safety and efficacy of using percutaneous ultrasound-guided radiofrequency ablation of early breast carcinoma in Egyptian Females. Patients: Thirteen patients were included in the study to be treated just before scheduled mastectomy or breast conserving surgery. Method: All patients were contraindicated or refused to do breast conservative surgery. A needle-shaped treatment electrode, with umbrella spreading end, was placed into the center of the lesions using ultrasound