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293 POSTER Local recurrence after breast conserving surgery: risk factors and prognostic relevance in 503 consecutive patients
S88
Poster session: Breast cancer
pathological size, DCIS-margin distance and residual disease on re-excision were analysed. Results: 135 patients underwent initial breast-conserving surgery for DCIS. The compromised margin rate was 72%, and the rate of residual disease on re-operation was 54%. On univariate analysis, underestimation of pathological size by mammography by >1cm occurred in 40% of those with compromised margins undergoing a therapeutic operation compared to only 14% of those with clear margins (p=0.02). However, on multivariate analysis only pathological size (OR=1.0;95%CI 1.037-1.128) and lack of preoperative diagnosis (OR=5.3;95%CI 1.859-15.08) were predictive of compromised margins. The presence of residual disease on re-excision was associated with increasing pathological size (OR=1.085;95%CI 1.038-1.134) and decreasing DCIS-margin distance (OR=6.694;95%CI 1.84-37.855). 29%(n=13/45) of lesions <3cm compared to 84% (n=27/32) of lesions >3cm had residual disease on re-operation (p<0.0001). Residual disease was present in 62%(n=34/55); 64%(n=7/11) and 17%(n=2/12) of patients with DCIS-margin distances <1mm; 1-2mm and 2-5mm respectively. Conclusion: Considerable underestimation of extent of DCIS by mammography occurs in a high proportion of patients with compromised margin in breast conservation. Patients at particularly high risk of residual disease on re-excision are those with lesions >3cm and those with DCIS-margin distances of <2mm. 291
POSTER
Non-invasive optical imaging in patients with breast cancer C. Richardson 1 , L. Enfield 2 , A. Gibson 2 , N. Everdell 2 , J. Hebden 2 , S. Arridge 2 , M. Keshtgar 1 , R. Sainsbury 1 , M. Douek 1 . 1 University College London, Surgery, London, United Kingdom; 2 University College London, Medical Physics and Bioengineering, London, United Kingdom Introduction: Optical tomography is a non-invasive imaging technique which uses near-infrared light to produce functional images of the breast. This technique can be performed without the need for breast compression and does not require the use of ionising radiation. Methods: Women diagnosed with primary invasive ductal carcinoma between May 2005 and February 2006 were prospectively recruited after obtaining ethical approval. The diagnosis was confirmed using triple assessment and all had a histological diagnosis prior to recruitment. After obtaining informed consent, each woman underwent preoperative optical imaging using a unique device developed at University College London (UCL). This device emits pulses of near-infrared light, which are absorbed and scattered to various degrees as the light passes through the tissue components of the breast. The haemoglobin concentration and oxygenation of the tissue are especially sensitive to the presence of the light particles. The transmitted light is collected by sensitive photon collecting detectors and images reconstructed using a sophisticated algorithm which has been developed at UCL. Results: Six patients consented to participate in the study; all had a diagnosis of unilateral primary invasive ductal carcinoma. In each case, an area of high absorption corresponding to high blood volume was visualised. These areas correlated with the position of the invasive carcinoma on conventional x-ray mammography. Conclusions: Invasive ductal carcinoma has been identified and localised using optical tomography without the need for breast compression or ionizing radiation. The technique was well tolerated, caused no discomfort and took, on average, ten minutes to acquire data for each image. 292
POSTER
Accuracy of axillary node sampling in conjunction with sentinel node biopsy in assessing the axillary node status of patients with breast cancer. A prospective study F. Lumachi 1 , U. Basso 2 , P. Burelli 3 , M. Semisa 4 , S. Zanella 1 , F. Marino 5 . 1 University of Padua, School of Medicine, Dept of Surg & Gastroenterol Sciences, 35128 Padova, Italy; 2 Azienda Ospedaliera, Medical Oncology, 35128 Padova, Italy; 3 Azienda Ospedaliera, Chirurgia Generale, 35105 Conegliano (TV), Italy; 4 Azienda Ospedaliera, Radiology, 35128 Padova, Italy; 5 University of Padua, School of Medicine, Dept of Pathology, 35128 Padova, Italy Background: The high accuracy of sentinel node biopsy (SNB) and con-
cerns regarding morbidity after standard axillary node dissection (AND) have translated into widespread use of this technique in the management of patients with early breast cancer (BC). The aim of this study was to assess the usefulness of axillary node sampling (ANS) in conjunction with SNB in improving the accuracy of SNB alone. Patients and Methods: One-hundred and nine consecutive women (median age 56 years, range 30-72 years) with biopsy- or FNAB-proven T1-2 BC undergoing curative surgery were enrolled in this study. Two Groups of patients were randomly selected. Group A (SNB alone): 53 patients, median age 54 years, and Group B (SNB and ANS): 56 patients, median age 58 years. In all patients a combined radioisotope (99mTc-sulfur colloid) and isosulfan blue day technique was used, and the SNB was guided by both the appearance of blue day in the nodes and the gamma probe. Positive SNB required AND in all patients. Results: Age of the patients (53±10 vs. 57±10 years; p=0.07), size of the tumor at final pathology (19.09.±1 vs. 21.0±9.2 mm; p=0.25), number of the removed nodes (19± 3 vs. 18±4; p=0.14), and total amount of drainage from the axilla did not differ between Groups. Intraoperative frozen section examination showed a sentinel node involvement in 31 (28.4%) patients (Group A=14, Group B=17), whilst final pathology showed micrometastases or undetected metastases in 9 further sentinel nodes (Group A=5, Group B=4). In Group B patients all the involved nodes have been correctly detected (100% sensitivity), whilst the sensitivity of SNB technique alone was 74% and the accuracy 89%. Conclusions: ANS in conjunction with SNB is a low-risk procedure that may improve the accuracy of SNB alone in patients with BC requiring axillary node status detection. 293
POSTER
Local recurrence after breast conserving surgery: risk factors and prognostic relevance in 503 consecutive patients A. Neri, D. Marrelli, E. Pinto, A. De Stefano, F. Mariani, C. Pedrazzani, G. De Marco, T. Cioppa, S. Caruso, F. Roviello. Surgical Oncology, Human and General Pathology, Siena, Italy Background: Breast-conserving surgery and axillary dissection followed by external beam radiation therapy has become the standard of care for women with early-stage breast cancer. Local recurrence occurs in 10-20% of patients treated with breast conserving surgery for stage I-II breast cancer. The aim of the present study is to investigate breast cancer local recurrence, potential risk factors and its prognostic impact. Methods: A total of 503 patients with invasive breast cancer treated with breast conserving surgery were included in the study. All patients underwent axillary dissection and postoperative radiotherapy and had negative margins at pathological examination. Median follow-up was 82 months. Local recurrence was classified as early when occurred within 2 years from surgery. The risk factors for local recurrence and overall survival were estimated by univariate and multivariate analyses. Results: Forty-six cases (9.1%) of local recurrence were observed, of which 11 within 24 months from surgery and 35 later. Mean time to local recurrence was 74.6 months (range 11-154). The majority of local recurrences appeared in the same quadrant of the index tumor (67.4%). Statistically significant risk factors for local recurrence were premenopausal status, peritumoral vascular invasion, multifocality and absence of estrogen receptors. Independent negative prognostic factors for overall survival at 5 and 10 years were N stage, absence of estrogen receptors and early time to recurrence. Overall survival at 10 years was 10.0% for patients with early recurrence, 87.5% for patients with late recurrence and 87.9% for patients without recurrence. In order to establish the different risk factors for early and late recurrences, univariate and multivariate analyses were performed comparing these subgroups with the patients without local recurrence. LVI resulted an independent risk factor for both early and late recurrence, absence of estrogen receptors resulted an independent risk factor for late recurrence only and age <45 years for early recurrence only. Conclusions: None of the studied clinico-pathological characteristics alone is determinant for the choice of surgical treatment. Younger patients treated with breast conserving surgery should receive an aggressive post-surgical treatment and should be followed with an intensive follow-up program when metastatic axillary lymph nodes, negative estrogen receptors or peritumoral vascular invasion are present.
Poster session: Breast cancer
pathological size, DCIS-margin distance and residual disease on re-excision were analysed. Results: 135 patients underwent initial breast-conserving surgery for DCIS. The compromised margin rate was 72%, and the rate of residual disease on re-operation was 54%. On univariate analysis, underestimation of pathological size by mammography by >1cm occurred in 40% of those with compromised margins undergoing a therapeutic operation compared to only 14% of those with clear margins (p=0.02). However, on multivariate analysis only pathological size (OR=1.0;95%CI 1.037-1.128) and lack of preoperative diagnosis (OR=5.3;95%CI 1.859-15.08) were predictive of compromised margins. The presence of residual disease on re-excision was associated with increasing pathological size (OR=1.085;95%CI 1.038-1.134) and decreasing DCIS-margin distance (OR=6.694;95%CI 1.84-37.855). 29%(n=13/45) of lesions <3cm compared to 84% (n=27/32) of lesions >3cm had residual disease on re-operation (p<0.0001). Residual disease was present in 62%(n=34/55); 64%(n=7/11) and 17%(n=2/12) of patients with DCIS-margin distances <1mm; 1-2mm and 2-5mm respectively. Conclusion: Considerable underestimation of extent of DCIS by mammography occurs in a high proportion of patients with compromised margin in breast conservation. Patients at particularly high risk of residual disease on re-excision are those with lesions >3cm and those with DCIS-margin distances of <2mm. 291
POSTER
Non-invasive optical imaging in patients with breast cancer C. Richardson 1 , L. Enfield 2 , A. Gibson 2 , N. Everdell 2 , J. Hebden 2 , S. Arridge 2 , M. Keshtgar 1 , R. Sainsbury 1 , M. Douek 1 . 1 University College London, Surgery, London, United Kingdom; 2 University College London, Medical Physics and Bioengineering, London, United Kingdom Introduction: Optical tomography is a non-invasive imaging technique which uses near-infrared light to produce functional images of the breast. This technique can be performed without the need for breast compression and does not require the use of ionising radiation. Methods: Women diagnosed with primary invasive ductal carcinoma between May 2005 and February 2006 were prospectively recruited after obtaining ethical approval. The diagnosis was confirmed using triple assessment and all had a histological diagnosis prior to recruitment. After obtaining informed consent, each woman underwent preoperative optical imaging using a unique device developed at University College London (UCL). This device emits pulses of near-infrared light, which are absorbed and scattered to various degrees as the light passes through the tissue components of the breast. The haemoglobin concentration and oxygenation of the tissue are especially sensitive to the presence of the light particles. The transmitted light is collected by sensitive photon collecting detectors and images reconstructed using a sophisticated algorithm which has been developed at UCL. Results: Six patients consented to participate in the study; all had a diagnosis of unilateral primary invasive ductal carcinoma. In each case, an area of high absorption corresponding to high blood volume was visualised. These areas correlated with the position of the invasive carcinoma on conventional x-ray mammography. Conclusions: Invasive ductal carcinoma has been identified and localised using optical tomography without the need for breast compression or ionizing radiation. The technique was well tolerated, caused no discomfort and took, on average, ten minutes to acquire data for each image. 292
POSTER
Accuracy of axillary node sampling in conjunction with sentinel node biopsy in assessing the axillary node status of patients with breast cancer. A prospective study F. Lumachi 1 , U. Basso 2 , P. Burelli 3 , M. Semisa 4 , S. Zanella 1 , F. Marino 5 . 1 University of Padua, School of Medicine, Dept of Surg & Gastroenterol Sciences, 35128 Padova, Italy; 2 Azienda Ospedaliera, Medical Oncology, 35128 Padova, Italy; 3 Azienda Ospedaliera, Chirurgia Generale, 35105 Conegliano (TV), Italy; 4 Azienda Ospedaliera, Radiology, 35128 Padova, Italy; 5 University of Padua, School of Medicine, Dept of Pathology, 35128 Padova, Italy Background: The high accuracy of sentinel node biopsy (SNB) and con-
cerns regarding morbidity after standard axillary node dissection (AND) have translated into widespread use of this technique in the management of patients with early breast cancer (BC). The aim of this study was to assess the usefulness of axillary node sampling (ANS) in conjunction with SNB in improving the accuracy of SNB alone. Patients and Methods: One-hundred and nine consecutive women (median age 56 years, range 30-72 years) with biopsy- or FNAB-proven T1-2 BC undergoing curative surgery were enrolled in this study. Two Groups of patients were randomly selected. Group A (SNB alone): 53 patients, median age 54 years, and Group B (SNB and ANS): 56 patients, median age 58 years. In all patients a combined radioisotope (99mTc-sulfur colloid) and isosulfan blue day technique was used, and the SNB was guided by both the appearance of blue day in the nodes and the gamma probe. Positive SNB required AND in all patients. Results: Age of the patients (53±10 vs. 57±10 years; p=0.07), size of the tumor at final pathology (19.09.±1 vs. 21.0±9.2 mm; p=0.25), number of the removed nodes (19± 3 vs. 18±4; p=0.14), and total amount of drainage from the axilla did not differ between Groups. Intraoperative frozen section examination showed a sentinel node involvement in 31 (28.4%) patients (Group A=14, Group B=17), whilst final pathology showed micrometastases or undetected metastases in 9 further sentinel nodes (Group A=5, Group B=4). In Group B patients all the involved nodes have been correctly detected (100% sensitivity), whilst the sensitivity of SNB technique alone was 74% and the accuracy 89%. Conclusions: ANS in conjunction with SNB is a low-risk procedure that may improve the accuracy of SNB alone in patients with BC requiring axillary node status detection. 293
POSTER
Local recurrence after breast conserving surgery: risk factors and prognostic relevance in 503 consecutive patients A. Neri, D. Marrelli, E. Pinto, A. De Stefano, F. Mariani, C. Pedrazzani, G. De Marco, T. Cioppa, S. Caruso, F. Roviello. Surgical Oncology, Human and General Pathology, Siena, Italy Background: Breast-conserving surgery and axillary dissection followed by external beam radiation therapy has become the standard of care for women with early-stage breast cancer. Local recurrence occurs in 10-20% of patients treated with breast conserving surgery for stage I-II breast cancer. The aim of the present study is to investigate breast cancer local recurrence, potential risk factors and its prognostic impact. Methods: A total of 503 patients with invasive breast cancer treated with breast conserving surgery were included in the study. All patients underwent axillary dissection and postoperative radiotherapy and had negative margins at pathological examination. Median follow-up was 82 months. Local recurrence was classified as early when occurred within 2 years from surgery. The risk factors for local recurrence and overall survival were estimated by univariate and multivariate analyses. Results: Forty-six cases (9.1%) of local recurrence were observed, of which 11 within 24 months from surgery and 35 later. Mean time to local recurrence was 74.6 months (range 11-154). The majority of local recurrences appeared in the same quadrant of the index tumor (67.4%). Statistically significant risk factors for local recurrence were premenopausal status, peritumoral vascular invasion, multifocality and absence of estrogen receptors. Independent negative prognostic factors for overall survival at 5 and 10 years were N stage, absence of estrogen receptors and early time to recurrence. Overall survival at 10 years was 10.0% for patients with early recurrence, 87.5% for patients with late recurrence and 87.9% for patients without recurrence. In order to establish the different risk factors for early and late recurrences, univariate and multivariate analyses were performed comparing these subgroups with the patients without local recurrence. LVI resulted an independent risk factor for both early and late recurrence, absence of estrogen receptors resulted an independent risk factor for late recurrence only and age <45 years for early recurrence only. Conclusions: None of the studied clinico-pathological characteristics alone is determinant for the choice of surgical treatment. Younger patients treated with breast conserving surgery should receive an aggressive post-surgical treatment and should be followed with an intensive follow-up program when metastatic axillary lymph nodes, negative estrogen receptors or peritumoral vascular invasion are present.