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87. Isolated tumour cells and breast cancer recurrence after core needle biopsy or fine needle aspiration cytology
S42 2 On behalf of the Scientific Committee of the NABON Breast Cancer Audit, Surgery, Amsterdam, Netherlands 3 On behalf of the Scientific Committee of the NABON Breast Cancer Audit, Plastic and Reconstructive Surgery, Rotterdam, Netherlands 4 On behalf of the Scientific Committee of the NABON Breast Cancer Audit, Oncology, Amsterdam, Netherlands 5 On behalf of the Scientific Committee of the NABON Breast Cancer Audit, Epidemiology, Utrecht, Netherlands 6 On behalf of the Scientific Committee of the NABON Breast Cancer Audit, Epidemiology, Enschede, Netherlands 7 On behalf of the Scientific Committee of the NABON Breast Cancer Audit, Pathology, Dordrecht, Netherlands 8 On behalf of the Scientific Committee of the NABON Breast Cancer Audit, Radiotherapy, Groningen, Netherlands 9 On behalf of the Scientific Committee of the NABON Breast Cancer Audit, Oncology, Maastricht, Netherlands 10 On behalf of the Scientific Committee of the NABON Breast Cancer Audit, Surgery, Utrecht, Netherlands
Background: At present, various treatment modalities are used to preserve the breast contour in patients diagnosed with invasive breast cancer: breast-conserving surgery (BCS), primary systemic therapy (PST) and immediate reconstruction after ablative surgery. The rate of BCS as a frequently used quality indicator does not appropriately reflect the clinically relevant outcome of breast contour preserving treatment since it reflects only the surgical effort. We addressed the involved treatment modalities by defining a new quality indicator: the rate of breast contour preserving procedures (BCPP). Material and methods: All invasive M0 breast cancer patients diagnosed and operated in the Netherlands between January 2011 and September 2013 were selected from the national NABON Breast Cancer Audit. The use of BCS, BCS following PST, and immediate reconstruction following mastectomy were calculated and BCPP was defined as the sum of the three treatment options. Results: A total of 34.423 patients were identified. Of them, 55% underwent BCS alone. Twenty-three percent of the patients with a T2-T3 tumour were treated with PST and an immediate reconstruction was performed in 16% of the patients who underwent ablative surgery. There was a large variation between hospitals in BCS (31-80%), the use of PST in patients with T2-T3 tumours (0-75%) and the performance of an immediate reconstruction after ablative surgery (0-63%). Age significantly affected the rate of BCS, the number of patients treated with PST and the percentage of immediate reconstructions after ablative surgery. Overall, BCPP was performed in 64% of all patients: by BCS alone in 55,3%, by BCS after PST in 3,5% and by an immediate reconstruction after a mastectomy in 5,6% of the patients. While BCPP and BCS rates were comparable in elderly patients (>70 years; 48 and 46% respectively), BCPP and BCS-rates deviated substantially in patients <40 years (62 and 34% respectively). The rate of BCPP also varied between different hospitals: 45-83%. Conclusions: A large variation is seen between hospitals on performing BCS, PST and immediate reconstruction after ablative surgery. The rate of BCPP provides meaningful information regarding satisfactory local results as it reflects the multidisciplinary effort to obtain a good cosmetic outcome. It provides additional information relative to the mere rate of BCS. Both the rate of BCS and BCPP vary largely between the hospitals. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.083
87. Isolated tumour cells and breast cancer recurrence after core needle biopsy or fine needle aspiration cytology T. Meretoja1, M. Leidenius1, J. Vironen2, P. Heikkila¨3, H. Joensuu4 1 Helsinki University Central Hospital, Breast Surgery Unit, Helsinki, Finland
ABSTRACTS 2
Helsinki University Central Hospital, Jorvi Hospital, Espoo, Finland Helsinki University Central Hospital, Department of Pathology, Helsinki, Finland 4 Helsinki University Central Hospital, Department of Oncology, Helsinki, Finland 3
Background: Some previous studies implicate that core needle biopsy (CNB) in breast cancer might cause isolated tumour cells (ITC) in sentinel nodes and even decrease prognosis when compared to fine needle aspiration cytology (FNAC). The aim of this study is to compare the prevalence of ITC in the sentinel nodes and breast cancer recurrences in patients with preoperative CNB or FNAC. Materials and methods: 1525 breast cancer patients, diagnosed either by CNB (n¼657) or FNAC (n¼868) were operated between Jan 2001 and Oct 2005 at the Helsinki University Central Hospital. The biopsy method was chosen by the preference of the radiologist performing the biopsy. All patients underwent either wide local excision or mastectomy, together with sentinel node biopsy, axillary lymph node dissection or both. Patients received adjuvant systemic therapy and radiotherapy according to local guidelines. Patients were followed-up according to routine clinical practice and further follow-up data on breast cancer survival and overall survival was acquired from the Finnish Cancer Registry. Results: ITC were found in 37 patients with FNAC and in 33 patients with CNB (P ¼ 0.798). During a median follow-up time of 9.5 years there were 191 deaths of which 65 were breast cancer specific (40 in FNAC group and 25 in CNB group). Distant metastases occurred in 67 patients with FNAC and 40 patients with CNB. Loco-regional recurrence took place in 45 patients with FNAC and 32 with CNB. The biopsy method was not associated with breast cancer specific survival (P ¼ 0.462), distant metastases (P ¼ 0.180) or loco-regional recurrence (P ¼ 0.610) in univariate cox-regression analyses. Patients with ITC in sentinel nodes had poorer breast cancer specific survival in univariate survival analysis than patients with tumour-negative axillary lymph nodes (P ¼ 0.002). Due to the small number of breast cancer specific deaths (N¼37) in this subgroup a multivariate Cox-regression analysis could not be conducted. Conclusions: The present study did not find an association between CNB and ITC in sentinel nodes. CNB was not associated with more breast cancer specific events in comparison to FNAC. The breast cancer specific survival seemed poorer in patients with ITC compared to node-negative patients, however, the reliability of this finding is hindered by the small number of events. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.084
88. Outcomes of immediate implant-based breast reconstruction using an acellular dermal matrix L. Cook1, M. Massa1, A. Kothari1, T. Kovacs1, H. Hamed1, M. Douek1 1 King’s College London, Research Oncology, London, United Kingdom Background: Despite widespread use of the ADMs in immediate implant based breast reconstruction there are mostly retrospective cohort studies of outcomes of this procedure. We evaluated the outcome of implant-based reconstruction with ADM at our institution. Material and methods: Prospectively collected data on all patients undergoing immediate breast reconstruction with the same ADM (Surgimend PRS, TEI, Boston), from January 2012-January 2014 were reviewed. Data was collected on patient demographics, co-morbidities, smoking history, adjuvant treatment and complications. Statistical analysis was carried out using the SPSS software package. Results: A total of 99 patients (138 reconstructions) met inclusion criteria (60 unilateral 39 bilateral reconstructions). Mean patient age was 48.6 years (range 20-73 SD 12.7) and mean length of stay 2.6
Background: At present, various treatment modalities are used to preserve the breast contour in patients diagnosed with invasive breast cancer: breast-conserving surgery (BCS), primary systemic therapy (PST) and immediate reconstruction after ablative surgery. The rate of BCS as a frequently used quality indicator does not appropriately reflect the clinically relevant outcome of breast contour preserving treatment since it reflects only the surgical effort. We addressed the involved treatment modalities by defining a new quality indicator: the rate of breast contour preserving procedures (BCPP). Material and methods: All invasive M0 breast cancer patients diagnosed and operated in the Netherlands between January 2011 and September 2013 were selected from the national NABON Breast Cancer Audit. The use of BCS, BCS following PST, and immediate reconstruction following mastectomy were calculated and BCPP was defined as the sum of the three treatment options. Results: A total of 34.423 patients were identified. Of them, 55% underwent BCS alone. Twenty-three percent of the patients with a T2-T3 tumour were treated with PST and an immediate reconstruction was performed in 16% of the patients who underwent ablative surgery. There was a large variation between hospitals in BCS (31-80%), the use of PST in patients with T2-T3 tumours (0-75%) and the performance of an immediate reconstruction after ablative surgery (0-63%). Age significantly affected the rate of BCS, the number of patients treated with PST and the percentage of immediate reconstructions after ablative surgery. Overall, BCPP was performed in 64% of all patients: by BCS alone in 55,3%, by BCS after PST in 3,5% and by an immediate reconstruction after a mastectomy in 5,6% of the patients. While BCPP and BCS rates were comparable in elderly patients (>70 years; 48 and 46% respectively), BCPP and BCS-rates deviated substantially in patients <40 years (62 and 34% respectively). The rate of BCPP also varied between different hospitals: 45-83%. Conclusions: A large variation is seen between hospitals on performing BCS, PST and immediate reconstruction after ablative surgery. The rate of BCPP provides meaningful information regarding satisfactory local results as it reflects the multidisciplinary effort to obtain a good cosmetic outcome. It provides additional information relative to the mere rate of BCS. Both the rate of BCS and BCPP vary largely between the hospitals. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.083
87. Isolated tumour cells and breast cancer recurrence after core needle biopsy or fine needle aspiration cytology T. Meretoja1, M. Leidenius1, J. Vironen2, P. Heikkila¨3, H. Joensuu4 1 Helsinki University Central Hospital, Breast Surgery Unit, Helsinki, Finland
ABSTRACTS 2
Helsinki University Central Hospital, Jorvi Hospital, Espoo, Finland Helsinki University Central Hospital, Department of Pathology, Helsinki, Finland 4 Helsinki University Central Hospital, Department of Oncology, Helsinki, Finland 3
Background: Some previous studies implicate that core needle biopsy (CNB) in breast cancer might cause isolated tumour cells (ITC) in sentinel nodes and even decrease prognosis when compared to fine needle aspiration cytology (FNAC). The aim of this study is to compare the prevalence of ITC in the sentinel nodes and breast cancer recurrences in patients with preoperative CNB or FNAC. Materials and methods: 1525 breast cancer patients, diagnosed either by CNB (n¼657) or FNAC (n¼868) were operated between Jan 2001 and Oct 2005 at the Helsinki University Central Hospital. The biopsy method was chosen by the preference of the radiologist performing the biopsy. All patients underwent either wide local excision or mastectomy, together with sentinel node biopsy, axillary lymph node dissection or both. Patients received adjuvant systemic therapy and radiotherapy according to local guidelines. Patients were followed-up according to routine clinical practice and further follow-up data on breast cancer survival and overall survival was acquired from the Finnish Cancer Registry. Results: ITC were found in 37 patients with FNAC and in 33 patients with CNB (P ¼ 0.798). During a median follow-up time of 9.5 years there were 191 deaths of which 65 were breast cancer specific (40 in FNAC group and 25 in CNB group). Distant metastases occurred in 67 patients with FNAC and 40 patients with CNB. Loco-regional recurrence took place in 45 patients with FNAC and 32 with CNB. The biopsy method was not associated with breast cancer specific survival (P ¼ 0.462), distant metastases (P ¼ 0.180) or loco-regional recurrence (P ¼ 0.610) in univariate cox-regression analyses. Patients with ITC in sentinel nodes had poorer breast cancer specific survival in univariate survival analysis than patients with tumour-negative axillary lymph nodes (P ¼ 0.002). Due to the small number of breast cancer specific deaths (N¼37) in this subgroup a multivariate Cox-regression analysis could not be conducted. Conclusions: The present study did not find an association between CNB and ITC in sentinel nodes. CNB was not associated with more breast cancer specific events in comparison to FNAC. The breast cancer specific survival seemed poorer in patients with ITC compared to node-negative patients, however, the reliability of this finding is hindered by the small number of events. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.084
88. Outcomes of immediate implant-based breast reconstruction using an acellular dermal matrix L. Cook1, M. Massa1, A. Kothari1, T. Kovacs1, H. Hamed1, M. Douek1 1 King’s College London, Research Oncology, London, United Kingdom Background: Despite widespread use of the ADMs in immediate implant based breast reconstruction there are mostly retrospective cohort studies of outcomes of this procedure. We evaluated the outcome of implant-based reconstruction with ADM at our institution. Material and methods: Prospectively collected data on all patients undergoing immediate breast reconstruction with the same ADM (Surgimend PRS, TEI, Boston), from January 2012-January 2014 were reviewed. Data was collected on patient demographics, co-morbidities, smoking history, adjuvant treatment and complications. Statistical analysis was carried out using the SPSS software package. Results: A total of 99 patients (138 reconstructions) met inclusion criteria (60 unilateral 39 bilateral reconstructions). Mean patient age was 48.6 years (range 20-73 SD 12.7) and mean length of stay 2.6